Journal of Epilepsy ResearchJournal of Epilepsy Researchhttp://www.j-epilepsy.org
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Feed provided by JER Click to visit.engThe Clinical Spectrum of Benign Epilepsy with Centro-Temporal Spikes: a Challenge in ...http://www.j-epilepsy.org/journal/view.php?number=124
<p>Benign epilepsy with centro-temporal spikes (BECTS) is the most common type of focal epilepsy in children; it is age-dependent and presumably genetic. Traditionally, children with BECTS have a very good prognosis, even without medical treatment, and are thought to show no neurological symptoms or cognitive deficits. However, many previous studies have shown that BECTS can present with various clinical and electroencephalographic characteristics that are commonly associated with neuropsychological deficits, including linguistic, cognitive, and behavioral impairment. The degree of the neuropsychological deficits appears to depend on the sleep cycle and the localization of epileptiform discharges. Furthermore, based on neurobiological studies, a complex interplay between the processes of brain maturation and the involvement of genes that confer susceptibility may contribute to a variety of different childhood epileptic syndromes with various neuropsychological deficits. Thus, BECTS, atypical benign focal epilepsy during childhood, status epilepticus of BECTS, Landau-Kleffner syndrome, and epileptic encephalopathy with continuous spike-and-wave during sleep are all considered different entities, but are part of a single spectrum of disorders. In clinical practice, we have to consider BECTS as benign only when there are no or only mild neuropsychological deficits before medical treatment.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--1-1.jpg' border=0></p>Original articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=124Headache and Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=125
<p>Headache, especially migraine, has long been associated with epilepsy, based on the common clinical features of these disorders. Both migraine and epilepsy have a genetic predisposition and share common pathophysiological mechanisms including an imbalance between excitatory and inhibitory factors that result in spells of altered brain function and autonomic symptoms. There are well-documented reports on the headache as a sole manifestation of epileptic seizure and headache is commonly associated with as preictal, ictal, and postictal symptoms in epilepsy patients. In addition, migraine and epilepsy are frequently described as highly comorbid conditions and several antiepileptic drugs are used for the patients with migraine as well as epilepsy. In the present review, we briefly discuss the connection between headache and epilepsy in various aspects, including classification, clinical features, epidemiology, genetics, pathophysiology, and treatment.</p>Original articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=125Could Cannabidiol be a Treatment Option for Intractable Childhood and Adolescent Epilepsy?http://www.j-epilepsy.org/journal/view.php?number=126
<p>Epilepsy is an important disease that affects brain function, particularly in those under 3 years old. Uncontrolled seizures can affect cognitive function and quality of life. For these reasons, many trials have been conducted to investigate treatments for pediatric epilepsy. Currently, many antiepileptic drugs are available for the treatment of epilepsy, but cases of intractable epilepsy continue to exist. In the past, cannabis has been tested as a potential treatment of intractable epilepsy. Since 2013, 10 epilepsy centers in America have conducted research regarding the efficacy of cannabis to treat epilepsy. Cannabis has many components, including cannabidiol (CBD) and Δ<sup>9</sup>-tetrahydrocannabinol (THC). THC has psychoactive properties exerted through its binding of the cannabinoid receptor (CBR) whereas CBD is a CBR antagonist. The inhibition of epilepsy by CBD may therefore be caused by various mechanisms, although the detailed mechanisms of CBD actions have not yet been well defined. In most studies, trial doses of CBD were 2?5 mg/kg/day. Several such studies have shown that CBD does have efficacy for treatment of epilepsy. Reported adverse effects of CBD were mostly mild, including drowsiness, diarrhea, and decreased appetite. Severe adverse reactions requiring treatment, such as status epilepticus, have also been reported but it is not clear that this is related to CBD. Furthermore, many previous studies have been limited by an open-label or survey design. In future, double-blind, controlled trials are required and the use of CBD to treat other neurological problems should also be investigated.</p>Original articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=126Can Therapeutic-Range Chronic Phenytoin Administration Cause Cerebellar Ataxia?http://www.j-epilepsy.org/journal/view.php?number=127
<p>Phenytoin (PHT) is a first line antiepileptic drug (AED) used to treat many epilepsy syndromes. As with other AEDs, there are various adverse effects associated with PHT. For this brief review, we searched for evidence of cerebellar ataxia as a chronic adverse effect of therapeutic-range PHT treatment. Many previous studies appeared related to this issue, but many of those studies were designed to resolve questions related to the persistent residual effects of toxic-range PHT therapy, or they were inconclusive due to an absence of critical information such as PHT serum concentration, cerebellar symptoms/signs, and other factors contributing to cerebellar degeneration. Nevertheless, there were a few reports suggesting that cerebellar ataxia may be a chronic adverse effect of therapeutic-range PHT therapy and that a possible pathomechanism for that effect is folate deficiency. Moreover, there is the possibility that there may be patient-specific susceptibility factors affecting ataxia. Further studies are needed to elucidate the incidence, risk factors, and pathomechanism of cerebellar ataxia as a chronic adverse effect of therapeutic-range PHT treatment.</p>Original articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=127Relative Safety of Different Antidepressants for Treatment of Depression in Chronic Epileptic ...http://www.j-epilepsy.org/journal/view.php?number=128
<sec>
<title>Background and Purpose</title>
<p>Depression is one of the major psychiatric comorbidities associated with epilepsy. The inconclusive results of antidepressants (ADs) regarding their safety in regard to convulsions have strongly contributed towards under treatment of depression in people with epilepsy (PWE). Thus, the present study was envisaged to assess the relative safety of four different classes of ADs regarding their convulsive potential in kindled/epileptic animals.</p></sec>
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<title>Methods</title>
<p>Kindling (an animal model to induce chronic epilepsy) was induced in male Swiss albino mice by administration of pentylenetetrazole subconvulsive doses (35 mg/kg, i.p.) at an interval of 48 ± 2 h for 42 days. The epileptic animals were treated with saline; imipramine (20 mg/kg/day i.p.); fluoxetine (20 mg/kg/day i.p.); venlafaxine (10 mg/kg/day i.p.) and mirtazapine (10 mg/kg/day i.p.) for 15 days. Except naive, animals were challenged with pentylenetetrazole subconvulsive dose (35 mg/kg, i.p.) on every 5<sup>th</sup> day to determine convulsion severity score, latency to first myoclonic jerk, latency to first tonic-clonic convulsions and numbers of tonic-clonic convulsions. Depression was also evaluated every 5<sup>th</sup> day employing tail suspension test 2 h after pentylenetetrazole subconvulsive dose.</p></sec>
<sec>
<title>Results</title>
<p>All ADs have been reported significant antidepressant potential however regarding their safety in regard to convulsions in epileptic animals, variable results are obtained. Chronic administration of venlafaxine and mirtazapine were found to have significant anticonvulsant effect in epileptic animals. The behavioral data was further corroborated by neurochemical findings.</p></sec>
<sec>
<title>Conclusions</title>
<p>The treatment with venlafaxine and mirtazapine can be considered safe for treatment of depression in epilepsy and may enhance anticonvulsant potential of antiepileptic drugs as an adjuvant therapy. However, pharmacokinetic studies are warranted before translating these findings in PWE.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--1-25.jpg' border=0></p>Review articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=128Anticonvulsant Effects of the Hydroalcoholic Extract of Alpinia officinarum Rhizomesin Mice: ...http://www.j-epilepsy.org/journal/view.php?number=129
<sec>
<title>Background and Purpose</title>
<p>Epilepsy is one of the most common serious neurological conditions. The current therapeutic treatment of epilepsy with modern antiepileptic drugs is associated with side effects, dose-related and chronic toxicity, and teratogenic effects and in approximately 30% of the patients is ineffective. <italic>Alpinia officinarum</italic> is used in Iranian traditional medicine for treatment of different diseases like back pain and seizure.</p></sec>
<sec>
<title>Methods</title>
<p>In this study, anticonvulsant effects of hydroalcoholic extract of <italic>Alpinia officinarum</italic> rhizomes were examined by using pentylentetrazole (PTZ) model in mice. <italic>Alpinia officinarum</italic> rhizomes extract (200, 400 and 600 mg/kg), diazepam (1 mg/kg) and normal saline (10 mL/kg) were injected (ip) 30 minutes before PTZ (90 mg/kg, ip). The time taken before the onset of clonic convulsions, the duration of colonic convulsions, and the percentage of seizure and mortality protection were recorded. For further clarification of the mechanism of action for <italic>Alpinia officinarum</italic>, flumazenil (2 mg/kg, ip) and naloxone (5 mg/kg, ip) were also injected 5 minutes before <italic>Alpinia officinarum</italic> extract.</p></sec>
<sec>
<title>Results</title>
<p><italic>Alpinia officinarum</italic> extract at the doses of 200 and 400 mg/kg prolonged the time of onset of seizure and decreased the duration of seizures compared to control (saline) group (<italic>p</italic> &lt; 0.05). At the dose of 600 mg/kg, percentage of seizure protection was 16.66%. Naloxone and flumazenil could suppress anticonvulsant effects of <italic>Alpinia officinarum</italic>.</p></sec>
<sec>
<title>Conclusions</title>
<p>It seems that <italic>Alpinia officinarum</italic> could be a good candidate and be useful for seizure control and treatment, and in these effects, opioid and benzodiazepine receptors might probably be involved.</p></sec>Review articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=129Recent Drug Resistant Epilepsy Spectrum in Eastern Indiahttp://www.j-epilepsy.org/journal/view.php?number=130
<sec>
<title>Background and Purpose</title>
<p>The Magnitude of Drug-resistant Epilepsy (DRE) in India, being unknown, takes a heavy toll on the patients and society in the form of prolonged dependence, unemployment, morbidity and mortality. We tried to explore the clinical, electro-physiological, neuro-imaging and drug-response spectrum of DRE patients in Eastern India in our study.</p></sec>
<sec>
<title>Methods</title>
<p>During the period of January 2014 to December 2015, epilepsy patients were treated and DRE patients were identified according to International League Against Epilepsy criteria. We isolated those patients and studied them in a special clinic.</p></sec>
<sec>
<title>Results</title>
<p>Among 2,153 patients treated in Neurology out-patient department, 243 (11.3%) patients were drug-resistant. Among the DRE patients, 63% were male. Age-wise 40%, 30.5% &amp; 18.1% patients were presented in their first, second and third decades respectively. Males were more affected in 0?5 years age group while females in 6?10 years age group. Various seizures types were found alone or in combination. Males were mostly affected by generalized tonic clonic seizure and myoclonus and females by complex partial seizure. Positive family history was higher in partial seizure group. Electroencephalographic (EEG) abnormalities were common with structural lesions in brain. EEG findings in different etiologies were varied with a large number of DRE patients who were found to have normal EEG. Females were higher medicine non-compliant.</p></sec>
<sec>
<title>Conclusions</title>
<p>The spectrum was pointed towards gender predilection for specific age group and also for seizure types. Idiopathic cases were most common in DRE, pointing towards the need of newer investigations. Normal EEG could be found even in a DRE patient. Non-compliance was more in females.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--1-39.jpg' border=0></p>Review articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=130Ketogenic Diet for the Management of Epilepsy Associated with Tuberous Sclerosis Complex in Childrenhttp://www.j-epilepsy.org/journal/view.php?number=131
<sec>
<title>Background and Purpose</title>
<p>In the present study, we reviewed the outcome of ketogenic diet (KD) use for the management of epilepsy in children with tuberous sclerosis complex (TSC).</p></sec>
<sec>
<title>Methods</title>
<p>A total of 12 children with intractable epilepsy associated with TSC who were treated with KD at our hospital between March 1, 2008 and February 28, 2015 were retrospectively enrolled.</p></sec>
<sec>
<title>Results</title>
<p>The mean age at the time of KD initiation was 73.1 ± 38.0 months. Patients were medically refractory to a mean of 4.8 ± 1.7 antiepileptic drugs. Nine patients (75.0%) had a history of infantile spasms. At 3 months after KD initiation, 10 patients (83.3%) had &gt; 50% seizure reduction. Moreover, 7 patients (58.3%) exhibited qualitative improvements in cognition and behavior after KD initiation, as reported by caregivers/parents. The mean duration of dietary therapy was 14.8 ± 12.8 months. Half of the patients in this study eventually underwent epilepsy surgery due to persistent seizures or seizure relapse.</p></sec>
<sec>
<title>Conclusion</title>
<p>KD is an important non-pharmacological treatment option for patients with intractable epilepsy associated with TSC. KD may improve cognition and behavior in addition to reducing seizure frequency.</p></sec>Review articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=131Knowledge and Awareness of Epilepsy Surgery among Medical Studentshttp://www.j-epilepsy.org/journal/view.php?number=132
<sec>
<title>Background and Purpose</title>
<p>Surgery is an alternative treatment of drug-resistant epilepsy. Positive attitude of medical personnel towards epilepsy surgery is essential. This study assessed general knowledge of and attitude towards epilepsy surgery among medical students. The aim of this study was to assess general knowledge of and attitude towards epilepsy surgery among medical students.</p></sec>
<sec>
<title>Methods</title>
<p>Questionnaire was distributed to medical students. Questionnaire consisted of two questions of general knowledge of drug-resistant epilepsy, questions of students’ attitude towards epilepsy surgery and questions of referral of patients. The Chi-square test was utilized.</p></sec>
<sec>
<title>Results</title>
<p>The terms “drug-resistant epilepsy” and “mesial temporal sclerosis” were known in 72.3 and 14.2 percent, respectively. Awareness and support of epilepsy surgery were recorded in 74.5 and 48.9 percent, respectively. A drug resistant patient would have been referred to a qualified centre in 19.4 percent. General knowledge and awareness of epilepsy surgery were better in higher levels of study (<italic>p</italic> &lt; 0.001).</p></sec>
<sec>
<title>Conclusions</title>
<p>Medical students have a positive attitude towards epilepsy surgery. Students are aware of drug resistance in epilepsy. Knowledge and awareness are better among students in higher levels, after neurology is introduced to the curriculum. We conclude that highlighting the importance of epilepsy surgery should be continued. Moreover, additional educational effort should be invested in expressing the importance of efficient referral of a patient to a qualified centre.</p></sec>Review articleFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=132Transient Epileptic Amnesia with Preserved Consciousness: a Report of Two Caseshttp://www.j-epilepsy.org/journal/view.php?number=133
<p>Transient epileptic amnesia (TEA) is defined as recurrent ictal and interictal transient memory disturbances typically occurring upon waking. Patients with TEA usually cannot remember the episodes. Electroencephalographic (EEG) abnormalities are usually localized on the dominant or bilateral temporal lobes. Here we report two cases of TEA with atypical features. The patients could remember the episodes afterwards, and abnormal discharges on EEG were detected in the temporal lobes of the non-dominant hemisphere. We suggest that confinement of epileptic discharge to the non-dominant temporal lobe can lead to partial preservation of consciousness during seizure attacks that produce transient amnesia.</p>Case ReportFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=133Palinacousis-Auditory Perseverationhttp://www.j-epilepsy.org/journal/view.php?number=134
<p>Palinacousis is an auditory illusion rarely reported in cases of temporal lobe dysfunction. After reviewing the literature and comparing our clinical experience, we believe that palinacousis can occur as an aura, a simple partial seizure, a complex partial seizure, and/or a postictal event. Palinacousis maybe more common than recognized in patients with receptive aphasias or diffuse cerebral dysfunction, whose language deficits preclude adequate description. We report the case of a 71 years old man with the previously diagnosis of an infarction of left middle cerebral artery and valvular heart disease who presented with the symptoms of palinacousis. He was not diagnosed psychotic diseases. An electroencephalography showed normal wave. He was diagnosed as temporal lobe epilepsy with palinacousis due to post-stroke. Palinacousis was completely reversed after treatment with antiepileptic drug. We report that palinacousis as an epileptic phenomenon can help localized potential lesions and can improve patient care.</p>Case ReportFri, 30 Jun 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=134Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?http://www.j-epilepsy.org/journal/view.php?number=135
<p>The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) - tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behavior have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations. Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes. Based on currently available information, however, it is unclear whether the improved seizure control described in these trials was related to a direct action of CBD, or was mediated by drug interactions with concomitant medications, particularly a marked increased in plasma levels of N-desmethylclobazam, the active metabolite of clobazam. Clarification of the relative contribution of CBD to improved seizure outcome requires re-assessment of trial data for the subgroup of patients not comedicated with clobazam, or the conduction of further studies controlling for the confounding effect of this interaction.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--2-61.jpg' border=0></p>Original articleSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=135Grey and White Matter Alterations in Juvenile Myoclonic Epilepsy: A Comprehensive Reviewhttp://www.j-epilepsy.org/journal/view.php?number=136
<p>Juvenile myoclonic epilepsy (JME) has been classified as a syndrome of idiopathic generalized epilepsy and is characterized by a strong genetic basis, age-specific onset of seizures, specific types of seizures, generalized spike-wave discharges on electroencephalography, and a lack of focal abnormality on magnetic resonance imaging (MRI). Recently, a wide range of advanced neuroimaging techniques have been utilized to elucidate the neuroanatomical substrates and pathophysiological mechanisms underlying JME. Specifically, a number of quantitative MRI studies have reported focal or regional abnormalities of the subcortical and cortical grey matter, particularly the thalamus and frontal cortex, in JME patients. In addition, diffusion tensor imaging studies have pointed to disrupted microstructural integrity of the corpus callosum and multiple frontal white matter tracts as well as thalamofrontal dysconnectivity in JME patients. Converging evidence from neuroimaging studies strongly suggests that JME is a predominantly thalamofrontal network epilepsy, challenging the traditional concept of JME as a generalized epilepsy. There is also limited evidence indicating extrafrontal and extrathalamic involvement in JME. This systematic review outlines the main findings from currently available MRI studies focusing on grey and white matter alterations, and discusses their contributions to the etiology and pathophysiology of JME. The clinical utility, advantages, and drawbacks of each imaging modality are briefly described as well.</p>Original articleSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=136Comparison of Autonomic Function before and after Surgical Intervention in Patients with ...http://www.j-epilepsy.org/journal/view.php?number=137
<sec>
<title>Background and Purpose</title>
<p>Refractory temporal lobe epilepsy (TLE) is commonly associated with imbalances in cardiovascular (CV) parasympathetic and sympathetic functions, which are treated using TLE surgery. We investigated the effect of hemispheric lateralization of seizure foci on autonomic CV functions before and after TLE surgery.</p></sec>
<sec>
<title>Methods</title>
<p>The study was conducted on patients with left TLE (LTLE, n = 23) and right TLE (RTLE, n = 30) undergoing unilateral TLE surgery. To assess the autonomic CV functions, changes in the heart rate (ΔHR) and blood pressure (BP) were measured using a standardized battery of autonomic reactivity tests before surgery and at 3 and 6 months after surgery.</p></sec>
<sec>
<title>Results</title>
<p>Before surgery, ΔHR and the expiration to inspiration ratio (E:I) during the deep breathing test were higher in the LTLE group than in the RTLE group (both <italic>p</italic> < 0.001), but both outcomes were comparable between the groups at 3 and 6 months. ΔHR decreased at 3 and 6 months (<italic>p</italic> < 0.001 and 0.01, respectively) compared with preoperative values. The E:I at 3 months in the LTLE group was lower (<italic>p</italic> = 0.04) than the preoperative values. Decrease in systolic BP during the head-up tilt test was greater in the LTLE group than in the RTLE group (<italic>p</italic> = 0.002) before surgery. The maximum increase in diastolic BP during the cold pressor test was lower in the RTLE group at 6 months than that before surgery (<italic>p</italic> = 0.001) and in the LTLE group (<italic>p</italic> = 0.002).</p></sec>
<sec>
<title>Conclusions</title>
<p>We found that hemispheric lateralization of seizure foci in the temporal lobe had a differential effect on autonomic CV functions before surgery. Before surgery, parasympathetic reactivity was higher in the LTLE group, and sympathetic reactivity was higher in the RTLE group. After surgery, autonomic CV functions were comparable between the groups, suggesting that TLE surgery stabilizes autonomic CV functions.</p></sec>Review articleSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=137Longitudinal Change in Thyroid Hormone Levels in Children with Epilepsy on a Ketogenic Diet: ...http://www.j-epilepsy.org/journal/view.php?number=138
<sec>
<title>Background and Purpose</title>
<p>The aim of this study is to evaluate the prevalence of hypothyroidism and the change of thyroid hormone level in the children with epilepsy on a ketogenic diet (KD).</p></sec>
<sec>
<title>Methods</title>
<p>The levels of serum free thyroxine (fT4) and thyroid-stimulation hormone (TSH) were measured at the start of the KD and at 6- to 12-month intervals in children with intractable epilepsy. Hypothyroidism was defined as fT4 level < 0.8 ng/dL and TSH level > 6.0 μIU/mL.</p></sec>
<sec>
<title>Results</title>
<p>A total of 28 children (17 boys and 11 girls) were enrolled in the study. The mean age of onset of seizure was 1.4 ± 1.6 years, the mean age of the start of the KD was 3.2 ± 2.4 years, and the mean duration of KD was 1.9 ± 1.5 years. Overall, there was no significant longitudinal change in the mean fT4 (0.99 ± 0.25 vs. 0.94 ± 0.71 ng/dL, <italic>p</italic> = 0.28) and TSH (2.94 ± 1.32 vs. 3.18 ± 1.21 μIU/mL, <italic>p</italic> = 0.44) levels from the start of the KD to last follow-up. The patients with a younger age of seizure onset, earlier initiation of KD, and higher serum levels of cholesterol and triglyceride had a significant decrease in fT4 levels and increase in TSH levels during the KD. Sex, duration of the seizure or KD therapy, seizure types, seizure frequency, seizure outcomes, brain lesion, ratio of KD, and being overweight did not affect the longitudinal change of fT4 and TSH levels during KD.</p></sec>
<sec>
<title>Conclusion</title>
<p>Thyroid function had no significant longitudinal decrease in pediatric epilepsy during KD therapy. However, careful monitoring of the serum levels of fT4/TSH should be recommended in children on KDs, especially in those with earlier seizure onset, earlier start of KD, and higher levels of lipid profiles.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--2-99.jpg' border=0></p>Review articleSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=138Levetiracetam-Induced Skin Hyperpigmentation: An Extremely Rare Undesirable Side Effecthttp://www.j-epilepsy.org/journal/view.php?number=139
<p>Levetiracetam is one of the newer second-generation antiepileptic drugs with multiple mechanisms of action. Cutaneous side effects due to levetiracetam are rarely reported in the literature. In this article, we describe a patient with skin hyperpigmentation due to the treatment with levetiracetam with complete resolution after discontinuation of the medication. In addition, we review the topic and hypothesize the mechanism behind this rare complication. To the best of our knowledge, this is the first report of skin hyperpigmentation as a side effect of levetiracetam in the literature. The prescribing physicians should inform the patients about all potential side effect of levetiracetam including skin hyperpigmentation. Similar to many undiagnosed conditions, increased awareness of their existence is the key to diagnosis. Early recognition and timely cessation of therapy are important to reverse this effect. Further studies should be conducted to explore the pathophysiology of this rare side effect.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--2-106.jpg' border=0></p>Case ReportSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=139Successful Use of Therapeutic Hypothermia for Refractory Nonconvulsive Status Epilepticushttp://www.j-epilepsy.org/journal/view.php?number=140
<p>Therapeutic hypothermia (TH) has rarely been utilized as an adjunct to anticonvulsants in treating patients with refractory convulsive status epilepticus (CSE). However, determining the effectiveness of TH in CSE is difficult due to the unavoidable use of sedative drugs to manage hypothermia. Additionally, the effectiveness of TH has not been studied in patients with refractory non-convulsive status epilepticus (NCSE). Here, we report the successful use of TH without additional sedative drugs in a patient with temporal lobe epilepsy and refractory NCSE. A 46-year-old man was referred to the neurology department because of recurrent seizure attacks. Electroencephalography (EEG) after first-line status treatment showed continuous periodic discharges consistent with NCSE. He was started simultaneously on continuous EEG monitoring and TH, but was not administered any benzodiazepines to control shivering or maintain TH. During TH, EEG abnormalities gradually improved, and the patient regained consciousness in accordance with the improvement in EEG. The patient was alert and his EEG had normalized a few days after starting TH. To the best of our knowledge, this is the first report describing the successful treatment of refractory NCSE with TH. As no sedative drugs were used during the maintenance of hypothermia, NCSE control may have been achieved by TH alone.</p>Case ReportSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=140Aphasic Status Epilepticus Associated with Uremiahttp://www.j-epilepsy.org/journal/view.php?number=141
<p>Aphasic status epilepticus (ASE) is a rare disorder characterized by recurrent aphasia without impairment of other cognitive functions. A 76-year-old woman with chronic kidney disease developed ASE after neglecting peritoneal dialysis. Magnetic resonance imaging failed to demonstrate an appropriate lesion. Electroencephalography demonstrated ictal discharges in the left frontotemporal leads. ASE disappeared after intravenous valproic acid and correction of uremia. This is the first case report of ASE in a patient with acute aggravation of uremia.</p>Case ReportSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=141A 6-Month-Old Girl with Incontinentia Pigmenti Presenting as Status Epilepticushttp://www.j-epilepsy.org/journal/view.php?number=142
<p>Incontinentia pigmenti (IP) is an uncommon neurocutaneous syndrome. Its initial diagnosis is based primarily on characteristic papulovesicular skin lesions and early-onset neonatal seizures. In contrast to typical early neurologic manifestations, we encountered a normally developed 6-month-old female patient with hyperpigmented whorls on her body. Following respiratory syncytial virus infection and fever, the patient exhibited status epilepticus. Brain magnetic resonance imaging studies of the patient were compatible with the findings of acute encephalopathy in IP. Genetic analysis showed an 11.7 kb deletion within the gene encoding inhibitor of kappa-B kinase gamma. The patient was treated with anticonvulsants and subsequently reached expected developmental milestones after discharge. These findings indicate that when a patient presents with status epilepticus, meticulous examination for skin lesions should be performed to determine whether the patient has a neurocutaneous syndrome, such as IP.</p>Case ReportSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=142Status Epilepticus as an Unusual Manifestation of Heat Strokehttp://www.j-epilepsy.org/journal/view.php?number=143
<p>Heat stroke (HS) is a medical emergency and life threatening condition, characterized by body temperature over 40°C. This can lead to dysfunction of multiple organs such as the heart, liver, kidneys, lungs, blood coagulation system, and central nervous system. Neurological complications include change in consciousness, cerebellar dysfunction, convulsions, aphasia, muscular weakness, and parkinsonism. Cerebellar syndrome is the most common neurological finding in HS. We report a case of HS presenting with status epilepticus, without any other neurological manifestations. A 42 year old man, previously diagnosed with bipolar disorder, was admitted to the emergency room with high fever and repetitive generalized tonic-clonic seizures. He had been found unconscious after 4 hours of heavy physical work under extremely hot weather conditions. He was diagnosed with HS accompanied by status epilepticus, and treated with emergency body cooling and antiepileptics. Five days after admission, he regained consciousness and the laboratory parameters that were initially abnormal returned to normal values. On day 14, he was discharged without any neurological complications.</p>Case ReportSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=143Intractable Epilepsy with Solitary Cerebral Calcificationhttp://www.j-epilepsy.org/journal/view.php?number=144
<p>Cerebral calcification is a common incidental finding upon brain imaging and its epileptogenicity is often underestimated. Here, we report a case of intractable epilepsy arising in conjunction with a solitary cerebral calcification. A 42-year-old male with intractable epilepsy was admitted to the epilepsy clinic for invasive epilepsy surgery. Brain magnetic resonance imaging revealed a slight high-intensity signal change in the right amygdala and a small, calcified lesion in the right lateral temporal region. The patient underwent invasive monitoring with subdural electrodes. He had five habitual seizures with automatisms and fast activity. These seizures initiated in the right lateral temporal area just above the solitary calcified lesion. Neuropathology of the calcified lesion showed no specific findings apart from a fibrocalcific nodule. Thus, although solitary cerebral calcifications may be an asymptomatic or coincidental finding in some patients, they may also have a highly epileptogenic focus.</p>Case ReportSun, 31 Dec 2017 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=144Ketogenic Diet, but Not Polyunsaturated Fatty Acid Diet, Reduces Spontaneous Seizures in ...http://www.j-epilepsy.org/journal/view.php?number=104
<sec>
<title>Background and Purpose:</title>
<p>The high-fat, low-carbohydrate ketogenic diet (KD) is effective in many cases of drug-resistant epilepsy, particularly in children. In the classic KD, fats consist primarily of long-chain saturated triglycerides. Polyunsaturated fatty acids (PUFAs), especially the n-3 type, decrease neuronal excitability and provide neuroprotection; pilot human studies have raised the possibility of using PUFAs to control seizures in patients.</p></sec>
<sec>
<title>Methods:</title>
<p>To determine the relative roles of the KD and PUFAs in an animal model, we induced epilepsy in juvenile rats (P29?35) using intraperitoneal kainic acid (KA). KA caused status epilepticus in all rats. Two days after KA, rats were randomized to one of 4 dietary groups: Control diet; PUFA diet; KD; or KD plus PUFA. All diets were administered isocalorically at 90% of the rat recommended daily calorie requirement. Spontaneous recurrent seizures (SRS) were assessed for 3 months after diet randomization.</p></sec>
<sec>
<title>Results:</title>
<p>Rats receiving the KD or KD-PUFA diet had significantly fewer SRS than those receiving the Control diet or PUFA diet. The PUFA diet did not reduce SRS compared to the Control diet.</p></sec>
<sec>
<title>Conclusions:</title>
<p>In the KA epilepsy model, the KD protects against SRS occurrence but dietary enhancement with PUFA does not afford additional protection against spontaneous seizures.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--1-1.jpg' border=0></p>Review articleThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=104Beta Lactams Antibiotic Ceftriaxone Modulates Seizures, Oxidative Stress and Connexin 43 ...http://www.j-epilepsy.org/journal/view.php?number=105
<sec>
<title>Background and Purpose:</title>
<p>This study aimed to investigate the effect of ceftriaxone on oxidative stress and gap junction protein (connexin 43, Cx-43) expression in pentylenetetrazole (PTZ) induced kindling model.</p></sec>
<sec>
<title>Methods:</title>
<p>Twenty four Sprague dawely rats were divided into 3 equal groups (a) normal group: normal rats. (b) PTZ kindled group: received PTZ at the dose of 50 mg/kg via intraperitoneal injection (i.p.) every other day for 2 weeks (c) ceftriaxone treated group: received ceftriaxone at the dose 200 mgkg/12 hrs via i.p. injection daily from the 6th dose of PTZ for 3 days. Racine score, latency before beginning the first myoclonic jerk and duration of the jerks used as parameters of behavioral assessment. Immunohistopathological study for Cx-43 expression in hippocampus and measurement of markers of oxidative stress (malondialdehyde [MDA], low reduced glutathione [GSH] and catalase [CAT]) in hippocampal neurons were done.</p></sec>
<sec>
<title>Results:</title>
<p>PTZ kindling was associated with behavioral changes (in the form high stage of Racine score, long seizure duration and short latency for the first jerk), enhanced oxidative stress state (as demonstrated by high MDA, low GSH and CAT) and up regulation of Cx43 in hippocampal regions. While, ceftriaxone treatment ameliorated, significantly, PTZ-induced convulsions and caused significant improvement in oxidative stress markers and Cx-43 expression in hippocamal regions (<italic>p</italic> < 0.05).</p></sec>
<sec>
<title>Conclusions:</title>
<p>These findings support the anticonvulsive effects of some beta-lactams antibiotics which could offer a possible contributor in the basic treatment of temporal lobe epilepsy. This effect might be due to reduction of oxidative stress and Cx43 expression.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--1-8.jpg' border=0></p>Review articleThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=105The Difference in Heart Rate Change between Temporal and Frontal Lobe Seizures during ...http://www.j-epilepsy.org/journal/view.php?number=106
<sec>
<title>Background and Purpose:</title>
<p>Heart rate (HR) change is easily seen in seizures. Tachycardia is frequently seen in temporal lobe epilepsy (TLE), rather than extra temporal lobe epilepsy (XTLE). We report the difference in the HR pattern between TLE and frontal lobe epilepsy (FLE) during peri-ictal period.</p></sec>
<sec>
<title>Methods:</title>
<p>The ECG data, collected during EEG monitoring, was used. To compare the HR pattern between FLE and TLE, we investigated the baseline HR, maximum HR, seizure onset to peak HR, HR change, and the time return to baseline.</p></sec>
<sec>
<title>Results:</title>
<p>A total of 198 seizures (FLE was 115, TLE was 83) were included in this study. The baseline HR (in TLE, 74.9 ± 17.2 and in FLE, 70.7 ± 11.5 bpm), there was no difference between two groups. But the mean duration of the increased HR was more prolonged in TLE group (93.8 ± 54.9 seconds) than the FLE group(39.0 ± 21.4 seconds) (<italic>p</italic> < 0.001), the time to peak HR of the TLE group (135.1 ± 19.1 seconds) was higher than FLE group (119.3 ± 19.7 seconds) (<italic>p</italic> = 0.027), and the HR change of the TLE group (60.0 ± 26.3 bpm) was more prominent than that of the FLE group (22.8 ± 26.2 seconds) (<italic>p</italic> < 0.001). Furthermore, a longer duration of HR increase was seen in that of the TLE group than FLE group.</p></sec>
<sec>
<title>Conclusions:</title>
<p>The HR change of the TLE group was more prominent and prolonged than that of the FLE group. Therefore, the HR change can be a pattern that differentiates TLE from FLE.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--1-16.jpg' border=0></p>Review articleThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=106Assessment of Time and Frequency Domain Parameters of Heart Rate Variability and Interictal ...http://www.j-epilepsy.org/journal/view.php?number=107
<sec>
<title>Background and Purpose:</title>
<p>Epilepsy is a disease known to occur with autonomous phenomenons. Earlier studies indicate decreased heart rate variability (HRV) during ictal and interictal periods among epilepsy patients. In this study, we aim to investigate cardiac rhythm abnormalities and HRV during interictal period between drug-na?ve patients with idiopathic generalized epilepsy (IGE) and healthy control group.</p></sec>
<sec>
<title>Methods:</title>
<p>Twenty-six patients with IGE and 26 healthy individuals included in the study. In order to eliminate any structural cardiac pathology, transthoracic echocardiography was performed in all subjects and time and frequency domain parameters of HRV were evaluated after 24-hour rhythm holter monitoring.</p></sec>
<sec>
<title>Results:</title>
<p>Between two groups, no significant difference was detected in terms of mean heart rate and maximum duration between the start of the Q waves and the end of the T waves (QT intervals). In the time domain analysis of HRV, no statically significant difference was detected for standard deviation of all R - R intervals and root-mean-square of successive differences between patient and control group (<italic>p</italic> = 0,070 and <italic>p</italic> = 0,104 respectively). In the frequency domain analysis of HRV, patients tended to display lower total power and very low frequency power than did healthy subjects, but the differences were not statistically significant.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Our results suggest that there is no major effect of the epilepsy on HRV in patients with IGE. It should be emphasized that, in this study, HRV was evaluated only in patients with IGE and that the results are not proper to be generalized for patients with partial seizures.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--1-22.jpg' border=0></p>Review articleThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=107An Atypical Presentation of Subacute Encephalopathy with Seizures in Chronic Alcoholism Syndromehttp://www.j-epilepsy.org/journal/view.php?number=108
<p>Subacute encephalopathy with seizures in chronic alcoholism syndrome is a rare clinical manifestation in patients with chronic alcohol abuse. We report the case of a patient with chronic alcoholism who presented with partial nonconvulsive status epilepticus associated with a thalamic lesion.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--1-28.jpg' border=0></p>Case ReportThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=108Intracranial Cortical Calcifications in a Focal Epilepsy Patient with Pseudohypoparathyroidismhttp://www.j-epilepsy.org/journal/view.php?number=109
<p>Patients with chronic parathyroid dysfunction often have intracranial calcification in deep gray matter (GM) and subcortical white matter (WM) of their brain. Some of them are also epilepsy patients. Although cortical etiologies are main cause of epileptic seizure, cortical calcification has not been reported in these patients. We report a newly diagnosed focal epilepsy patient whose brain magnetic resonance imaging revealed intracranial calcifications in cortical as well as subcortical areas. Blood lab revealed that he had hypocalcemia due to pseudohypoparathyroidism. Video EEG monitoring revealed the ictal EEG mainly consist of polymorphic delta to theta waves with maximum at right temporal area followed by background attenuation and muscle artifacts. The interictal EEG showed multiple focal spike-wave discharges. After given oral calcium and calcitriol supplement, his calcium and phosphorous level normalized and he remains seizure free. This is the first case to show cortical calcification in a patient with pseudohypoparathyroidism. Cortical calcification could be an important measure of seizure burden in these patients and thus sophisticated imaging protocols should be used to visualize the extent of calcium deposits.</p>Case ReportThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=109A Case of Phenytoin-induced Rhabdomyolysis in Status Epilepticushttp://www.j-epilepsy.org/journal/view.php?number=110
<p>Phenytoin is a commonly used antiepileptic drug, especially when treating status epilepticus. Here, we present a patient who suffered from status epilepticus and developed rhabdomyolysis after being treated with phenytoin. As multiple seizures itself can induce rhabdomyolysis, it is difficult to recognize that phenytoin can be the cause of rhabdomyolysis in status epilepticus patients. Even though phenytoin is a rare cause of rhabdomyolysis, we should discern that phenytoin can be a causative drug to bring about rhabdomyolysis.</p>Case ReportThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=110Supra-recommendation Treatment of Super-refractory Status Epilepticushttp://www.j-epilepsy.org/journal/view.php?number=111
<p>A 28-year old female was admitted with recurrent seizures following 2 days of febrile illness, after which she developed status epilepticus. Midazolam and later thiopentone infusions were started after failure of regular intravenous antiepileptics. Burst suppression was achieved at doses of 3 mg/kg/hr for midazolam and 6 mg/kg/hr of thiopentone. Adjunctive medications included methylprednisolone, intravenous immunoglobulin and acyclovir. Imaging and biochemical parameters were normal. She required 3 cycles of midazolam and 2 cycles of thiopentone for complete cessation of seizures. She recovered with mild attentional and recent memory deficits on follow up. Treatment of super-refractory status epilepticus requires individualized regimens and may need doses beyond conventional limits. To the best of our knowledge, there is no such reported case from India.</p>Case ReportThu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=111Atrophy is a Real Phenomenon that Can Result in Changes in Deep Brain Stimulation Outcomehttp://www.j-epilepsy.org/journal/view.php?number=112
Thu, 30 Jun 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=112The Laboratory Diagnosis of Autoimmune Encephalitishttp://www.j-epilepsy.org/journal/view.php?number=113
<p>Autoimmune encephalitis is a group of encephalitis syndromes that cause altered mentality, memory decline, or seizures in association with the presence of serum and cerebrospinal fluid (CSF) autoantibodies (auto-Abs). An early diagnosis enables early treatments. The detection of auto-Abs is a confirmatory diagnosis. Tissue-based assay, cell-based immunoassay, and immunoblotting are used to detect various autoantibodies. The CSF test for the presence of antibodies is important because it is more sensitive and reflects disease activity in many autoimmune encephalitis, although antibody tests can be negative even in the presence of autoimmune encephalitis. EEG is often abnormal, but nonspecific. A unilateral or bilateral medial temporal T2 high signal is a common finding in MRI. Fludeoxyglucose-positron emission tomography is sometimes useful for diagnosis in patients with normal MRI.</p>Original articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=113Anticonvulsive Effects of Licofelone on Status Epilepticus Induced by Lithium-pilocarpine in ...http://www.j-epilepsy.org/journal/view.php?number=114
<sec>
<title>Background and Purpose</title>
<p>Status epilepticus (SE) is a neurological disorder with high prevalence and mortality rates, requiring immediate intervention. Licofelone is a cyclooxygenase (COX) and 5-lipoxygenase (5-LOX) inhibitor, which its effectiveness to treat osteoarthritis has been approved. Increasing evidence suggests an involvement of COX and LOX enzymes in epileptic disorders. Thus, in the present study we investigate possible effects of licofelone on prevention and termination of SE. We also evaluated whether the nitrergic system could participate in this effect of licofelone.</p></sec>
<sec>
<title>Methods</title>
<p>We have utilized lithium-pilocarpine model of SE in adult Wistar rats to assess the potential effect of licofelone on seizure susceptibility. Licofelone was administered 1 h before pilocarpine. To evaluate probable role of nitric oxide (NO) system, L-arginine (60 mg/kg, i.p.), as a NO precursor; L-NAME (15 mg/kg, i.p.), as a non-selective nitric oxide synthase (NOS) inhibitor; aminoguanidine (100 mg/kg, i.p.), as an inducible NOS (iNOS) inhibitor and 7-nitroindazole (60 mg/kg, i.p.), as a neuronal NOS inhibitor were injected 15 min before licofelone. Also, licofelone and diazepam 10 mg/kg were administered 30 minutes after onset of SE.</p></sec>
<sec>
<title>Results</title>
<p>Pre-treatment with licofelone at the dosage of 10 mg/kg, significantly prevented the onset of SE in all subjects (<italic>p</italic> &lt; 0.001). L-arginine significantly inverted this anticonvulsant effect (<italic>p</italic> &lt; 0.05). However, L-NAME and aminoguanidine, potentiated the anticonvulsant effect of licofelone (<italic>p</italic> &lt; 0.05, <italic>p</italic> &lt; 0.01). Licofelone could not terminate seizures after onset which was terminated by diazepam.</p></sec>
<sec>
<title>Conclusions</title>
<p>Our findings showed that anticonvulsive effects of licofelone on SE could be mediated by iNOS. Also, we suggest that COX/5-LOX activation is possibly required in the initial stage of onset but SE recruits extra excitatory pathways with prolongation.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--2-51.jpg' border=0></p>Review articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=114Psychometric Properties of the Persian Version of the Quality of Life in Epilepsy Inventory in ...http://www.j-epilepsy.org/journal/view.php?number=115
<sec>
<title>Background and Purpose</title>
<p>The reports indicate on the incidence of seizure disorder about 1.5 per cent of the normal elderly population. The Quality of Life in Epilepsy Inventory (QOLIE-31) has been pervasive simple tool to screen seizure in the busy neurophysiological settings and monitoring. It was constructed as self-administered tool in two formats, 89 and 31-items. To the reliability and validity of the QOLIE-31 across older adults in the southwest Iran and discuss its role in the detection of health-related quality of elderly patients with epilepsy.</p></sec>
<sec>
<title>Methods</title>
<p>About 73 older adults (mean age = 66.3 ± 1.71) were sampled from the eight hospitals and caring centres. They replied to the QOLIE-31. External and criterion validity was calculated by correlation to the SF-36 questionnaire, to check and validate the epilepsy specific dimensions. The QOLIE-31 includes seven subscales: overall quality of life, seizure worry, emotional well-being, energy/fatigue, cognitive, medication effects, and social function.</p></sec>
<sec>
<title>Results</title>
<p>There was significant difference within sample groups regarding main variables (<italic>p</italic> &lt; 0.05). The coefficients of Cronbach’s alpha (α= 0.76), convergent validity (0.81), divergent validity (?0.21), external validity with overall score of SF-36 (0.87), and criterion validity (0.78) were estimated, which were significant at <italic>p</italic> &lt; 0.01. The exploratory factor analysis demonstrated that the QOLIE-31 is organized into six factors, which clarifies 92 per cent of the scale’s variance. Second-order confirmatory factor analysis pointed out that the factor is well matched up onto a principal factor. Consequently, the 6-factors model was well appropriate for the data by the fit index techniques for adjusting the scale (AGFI = 0.94, GFI = 0.96, RMSEA = 0.003, IFI = 0.90, NFI = 0.95, CFI = 0.95).</p></sec>
<sec>
<title>Conclusions</title>
<p>The results pointed to the well-adjusted reliability and psychometric properties of the QOLIE-31 and its usefulness for the relevant studies as well.</p></sec>Review articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=115Change of Patient Selection Strategy and Improved Surgical Outcome in MRI-negative Neocortical ...http://www.j-epilepsy.org/journal/view.php?number=116
<sec>
<title>Background and Purpose</title>
<p>It is crucial to make selection strategy to identify surgical candidates among medically refractory MRI-negative neocortical epilepsy patients. In our previous study, we suggested two or more concordance between noninvasive studies (EEG, ictal scalp EEG, interictal FDG-PET, and SPECT) as a new patient selection strategy for MRI-negative neocortical epilepsy surgery. The objective of this study was to evaluate the surgical outcomes of MRI-negative neocortical epilepsy patients before and after the implementation of a new selection strategy.</p></sec>
<sec>
<title>Methods</title>
<p>From 1995 to 2011, we included 153 consecutive MRI-negative neocortical epilepsy patients who received focal resection and had a follow-up period of at least 2 years. These patients were divided into two groups according to their date of surgery (before and after July 2002). The old group consisted of 89 patients and the new one consisted of 53 patients. Clinical characteristics, presurgical evaluations, and pathology were reviewed.</p></sec>
<sec>
<title>Results</title>
<p>The new patient selection strategy led to a significant increase in the concordance between two or more modalities. The improvement in surgical outcome after 2002 was significant (seizure-free outcome, 47.2% vs. 75.5%; <italic>p</italic> = 0.001). Concordance between two or more presurgical evaluations and localizing PET were related to a seizure-free outcome in a multivariate analysis.</p></sec>
<sec>
<title>Conclusions</title>
<p>After a change in surgical strategy to select patients with two or more concordance between noninvasive studies, the seizure-free outcome improved up to 75.5%. MRI-negative neocortical epilepsy patients with two or more concordance between noninvasive studies seem to be good candidates for epilepsy surgery.</p></sec>Review articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=116Focal Epileptogenic Lesions in Adult Patients with Epilepsy and Generalized Epileptiform Dischargeshttp://www.j-epilepsy.org/journal/view.php?number=117
<sec>
<title>Background and Purpose</title>
<p>There are reports of successful resective epilepsy surgery for pediatric patients with epilepsy and generalized epileptiform discharges when they had focal epileptogenic lesions identified by MRI. However, there is limited information regarding adult patients with epilepsy who have both generalized epileptiform discharges and focal epileptogenic lesions.</p></sec>
<sec>
<title>Methods</title>
<p>To investigate the incidence and characteristics of adult patients who have both generalized epileptiform discharges and potentially epileptogenic lesions, we retrospectively analyzed data of clinical features and results of EEG and MRI of all patients with adult-onset epilepsy in a tertiary referral hospital.</p></sec>
<sec>
<title>Results</title>
<p>While 1315 patients were classified as having partial seizures, 207 patients were classified as having generalized seizures. Five of 207 patients (2.4%) with generalized seizures had potentially epileptogenic lesions. All the epileptogenic lesions were congenital or acquired during early life, such as focal cortical dysplasia, dysembryoplastic neuroepithelial tumor, and cerebromalacic change because of perinatal injury.</p></sec>
<sec>
<title>Conclusions</title>
<p>The presence of epileptogenic lesions in adult patients with generalized epileptiform discharges may be an incidental finding, but it has been suggested that some adult-onset epilepsy with generalized epileptiform discharges may actually have focal onset, which may have significant clinical implications for the choice of appropriate treatment.</p></sec>Review articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=117Excessive Daytime Sleepiness and Sleep Disorders in a Population of Patients with Epilepsy: a ...http://www.j-epilepsy.org/journal/view.php?number=118
<sec>
<title>Background and Purpose</title>
<p>There are several primary causes for excessive daytime sleepiness (EDS) and sleep disorders in patients with epilepsy. Up to now, studies in the literature report conflicting data in terms of both prevalence and aetiology. The aim of our study was therefore to evaluate the prevalence of EDS and some sleep disorders in a population of patients with epilepsy treated with no more than two antiepileptic drugs (AEDs). We also investigated the role of the depression of mood as a variable that can negatively affect EDS.</p></sec>
<sec>
<title>Methods</title>
<p>We prospectively and consecutively recruited 99 patients with a diagnosis of epilepsy, sleep disorders and EDS, belonging to the Centre for Epilepsy of the Department of Experimental Biomedicine and Clinical Neurosciences of the University of Palermo. 61.6% of patients recruited were suffering from focal epilepsy, and 38.3% from generalized epilepsy. 68.6% were undertaking monotherapy and 27.2% were drug resistant. Patients were matched for sex and age (+/? 5 years) with 96 non epileptic controls recruited from high school students, college students, relatives and friends of the medical team that conducted the study. EDS was found in 11.1% of patients with epilepsy. Clinical evaluation of sleep disorders was performed using validated questionnaires to investigate excessive daytime sleepiness (EDS), insomnia, Restless Legs Syndrome (RLS) and Obstructive Sleep Apnoea Syndrome (OSAS). In a second phase of the study, 43 of the investigated patients and 34 controls - after giving their consent - underwent a polysomnographic examination by “Compumedics Somt?”.</p></sec>
<sec>
<title>Results</title>
<p>Our study shows a statistically significant difference between cases and controls with regard to the prevalence of RLS (<italic>p</italic> = 0.022) and severity of OSAS with an increased risk in moderate-severe forms of epilepsy (odd ratio [OR] 2.5) most significantly associated with male gender (<italic>p</italic> = 0.04) and focal epilepsy (OR 3.8) with PSG seizures (0.02). Moreover, a statistically significant difference was demonstrated about mood disorders (<italic>p</italic> = 0.001) among patients with epilepsy and non epileptic controls. Sleepiness in patients with epilepsy seems to be particularly related to both the depression of mood (<italic>p</italic> = 0.01) and the presence of OSAS (<italic>p</italic> = 0.03), as well as to a higher mean age (<italic>p</italic> = 0.006) and a longer duration of illness (<italic>p</italic> = 0.04).</p></sec>
<sec>
<title>Conclusions</title>
<p>Our results confirm that drowsiness trouble frequently complained by patients with epilepsy, is particularly related not only to the presence of OSAS but also to the depression of mood.</p></sec>Review articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=118Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in ...http://www.j-epilepsy.org/journal/view.php?number=119
<sec>
<title>Background and Purpose</title>
<p>Aromatic antiepileptic drugs are frequently implicated for cutaneous adverse drug reactions (cADRs); there are case-reports of even severe reactions like drug reaction eosinophilia and systemic symptoms (DRESS) and Stevens Johnson syndrome (SJS)-toxic epidermal necrolysis with Levetiracetam (LEV). Certain human leukocyte antigen (HLA)-alleles have strong association with cADRs due to specific drugs - HLA-B*15:02 and HLA-A*31:01 in Carbamazepine (CBZ)-related SJS in Han-Chinese and European populations, respectively. Here, the spectrum of cADRs to LEV was studied, and HLA-typing in patients with cADRs due to LEV and some who were LEV-tolerant was performed, in an attempt to find an association between HLA and such reactions.</p></sec>
<sec>
<title>Methods</title>
<p>589 patients taking LEV were screened for skin reactions, and eight patients with LEV-related cADRs and 25 LEV-tolerant controls were recruited - all 33 of North Indian ethnicity, their HLA-A, B, DRB1 genotyping done. Statistical analysis was done to compare carrier-rates and allele-frequencies of HLA-alleles between cases and controls (and healthy population, where necessary) for alleles occurring more than two times in either group.</p></sec>
<sec>
<title>Results</title>
<p>Out of 589 patients on LEV screened, there were 8 cases of cADR: 5 with maculopapular exanthema (MPE), 2 of SJS, and 1 with DRESS. Although HLA-A*33:01 was seen to occur more in MPE cases as compared to tolerant controls, the difference was not statistically significant (odds ratio [OR] 6.00, 95% confidence interval [CI] 0.30?116.6; <italic>p</italic> = 0.31). HLA A*11:01 and 24:02 were found to occur more in LEV-tolerant controls than in cases (OR 0.23 [95% CI 0.02?2.36, <italic>p</italic> = 0.33] and 1.00 [95% CI 0.09?11.02, <italic>p</italic> = 1.00] respectively).</p></sec>
<sec>
<title>Conclusions</title>
<p>Cutaneous reactions to LEV are very unusual, and their association with HLA in North-Indian population was not statistically significant.</p></sec>Review articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=119Evaluation of Ictal Consciousness in Temporal and Extra Temporal Epilepsy: Observations from a ...http://www.j-epilepsy.org/journal/view.php?number=120
<sec>
<title>Background and Purpose</title>
<p>Differences in consciousness during seizures depend on the location of the seizure onset.</p></sec>
<sec>
<title>Methods</title>
<p>The present study evaluates ictal consciousness using the ictal consciousness inventory (ICI) in drug refractory mesial temporal (MTLE), neocortical temporal (NTLE) and extra temporal epilepsy (ETLE). This was a cross sectional cohort study with 45 patients with mesial temporal epilepsy, 47 with extra temporal and 11 patients with neocortical temporal epilepsy. The ICI a 20 item questionnaire was used to calculate the scores for level (L, question 1?10) and content (C, question 11?20) of consciousness.</p></sec>
<sec>
<title>Results</title>
<p>The patients in mesial temporal group had higher ICI-L scores, <italic>p</italic> = 0.0129 as compared to the extra temporal group, but no difference was observed in the content of consciousness. The ICI-L and C scores were not different in the mesial temporal and the neocortical temporal group (<italic>p</italic> = 0.53 and 0.65) respectively.</p></sec>
<sec>
<title>Conclusions</title>
<p>Patients with mesial temporal epilepsy had a higher level of consciousness than the extra temporal group but there was no difference in the content. Also there was no difference in the level and content of consciousness between mesial and the neocortical temporal group.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--2-93.jpg' border=0></p>Review articleWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=120Cefepime-Induced Non-Convulsive Status Epilepticus in a Patient with Normal Renal Functionhttp://www.j-epilepsy.org/journal/view.php?number=121
<p>Cefepime-induced encephalopathy including nonconvulsive status epilepticus has been known to develop in the patients with renal impairment. However, we report a 74-year-old woman with normal renal function who developed stuporous mental status during cefepime administration. Electroencephalogram (EEG) revealed 2 Hz rhythmic sharp-and-waves continuously, which suggested nonconvulsive status epilepticus (NCSE). After cefepime discontinuation, clinical symptoms recovered gradually and EEG findings showed only background slowing without epileptiform discharges. Cefepime-induced NCSE could be developed even in the patients with normal renal function, when they are elderly. Therefore, clinicians should be aware of the possibility of cefepime-induced NCSE when prescribing cefepime even to the patients with normal renal function.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--2-97.jpg' border=0></p>Case ReportWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=121Intermittent Theta Slowings in Contralateral Side of Weakness after Sleep Deprivation on Spot ...http://www.j-epilepsy.org/journal/view.php?number=122
<p>Hemiplegic migraine (HM) is an uncommon type of migraine which is classified into sporadic and familial subtype. The noticed electroencephalogram (EEG) findings during HM attack are diffuse slowing contralateral to the weakened limb, but are usually normal in asymptomatic states.</p>
<p>A 52-year-old woman who suffered from headache accompanying right arm weakness and aphasic symptoms admitted to our hospital. She underwent total five times of EEG including 2 times before admission. Only the last EEG exam after 24 hours of sleep deprivation (SD) showed intermittent slowing and higher amplitude of positive occipital sharp transients (POSTs) on the left parieto-occipital area. Here, we report a case with HM who revealed abnormal EEG findings after SD, which was not observed in the routine EEG study without SD.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--2-100.jpg' border=0></p>Case ReportWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=122CADASIL Initially Presented with a Seizurehttp://www.j-epilepsy.org/journal/view.php?number=123
<p>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease of the cerebral small blood vessels characterized by recurrent ischemic strokes, migraine, and progressive cognitive impairment. In patients with CADASIL, in whom subcortical white matter structures are typically involved, epileptic seizures have been rarely reported as an initial clinical symptom. We describe a patient genetically confirmed as having CADASIL who initially presented with a seizure.</p>Case ReportWed, 28 Dec 2016 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=123Pharmacoresistant Epilepsy: A Current Update on Non-Conventional Pharmacological and ...http://www.j-epilepsy.org/journal/view.php?number=86
<p>Uncontrolled seizure or epilepsy is intricately related with an increase risk of pharmacoresistant epilepsy. The failure to achieve seizure control with the first or second drug trial of an anticonvulsant medication given at the appropriate daily dosage is termed as pharmacoresistance, despite the fact that these drugs possess different modes of action. It is one of the devastating neurological disorders act as major culprit of mortality in developed as well as developing countries with towering prevalence. Indeed, the presence of several anti-epileptic drug including carbamazepine, phenytoin, valproate, gabapentin etc. But no promising therapeutic remedies available to manage pharmacoresistance in the present clinical scenario. Hence, utility of alternative strategies in management of resistance epilepsy is increased which further possible by continuing developing of promising therapeutic interventions to manage this insidious condition adequately. Strategies include add on therapy with adenosine, verapamil etc or ketogenic diet, vagus nerve stimulation, focal cooling or standard drugs in combinations have shown some promising results. In this review we will shed light on the current pharmacological and non pharmacological mediator with their potential pleiotropic action on pharmacoresistant epilepsy.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--1-1.jpg' border=0></p>Original articleTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=86Parentshttp://www.j-epilepsy.org/journal/view.php?number=87
<sec>
<title>Background and Purpose:</title>
<p>Many parents express worries about potential negative side effects of antiepileptic drugs (AED) on cognition, behavior, mood, and academic achievement. We aimed to evaluate parents’ subjective feelings about cognitive or behavioral changes in their children and their quality of life after antiepileptic drug (AED) discontinuation.</p></sec>
<sec>
<title>Methods:</title>
<p>A modified questionnaire based on the Korean-Quality of Life in Childhood Epilepsy and the Korean-Child Behavior Checklist was answered by parents whose children were seizure-free over the course of 1 month after AED discontinuation. All children were seizure-free for at least 2 years before AED withdrawal.</p></sec>
<sec>
<title>Results:</title>
<p>Fifty-eight eligible patients (mean age, 14.1 ± 4.5 years) were examined. Except valproate in cognition (<italic>p</italic> = 0.03), parents did not feel significant change after discontinuation of different drugs. They felt improvement of behavior in generalized epilepsy (<italic>p</italic> = 0.04) and better quality of life in children less than 6 year of age at diagnosis of epilepsy (<italic>p</italic> = 0.02).</p></sec>
<sec>
<title>Conclusions:</title>
<p>We propose that factors such as earlier age at diagnosis of epilepsy or type of epilepsy might influence parents’ subjective feelings about their children’s well-being after drug discontinuation, rather than the drug itself.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--1-9.jpg' border=0></p>Review articleTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=87Evaluation of Short-term Mortality of Status Epilepticus and Its Risk Factorshttp://www.j-epilepsy.org/journal/view.php?number=88
<sec>
<title>Background and Purpose:</title>
<p>Status epilepticus (SE) is defined as epileptic seizures of greater than five minutes or more than one seizure within a five minute period without returning to normal consciousness between them. It is a life-threatening condition particularly if treatment is delayed. Previous studies reported age, duration and etiology of SE as primary determinants of mortality.</p></sec>
<sec>
<title>Methods:</title>
<p>This prospective cross-sectional study performed on the patients with status epilepticus admitted in Rasoul-e-Akram hospital in Tehran. Patients followed at 30th day after SE to assess their living status.</p></sec>
<sec>
<title>Results:</title>
<p>Sixty-five patients, (56.9% was male) with 15 to 88 years of age entered the study. Mean duration of SE was 40 minutes and for hospital stay was 7 days. 84.6% of patients responded to treatment and 11 patients (16.9%) died within 30 days after SE. Mortality rate in patients with refractory SE was 70%. Mean interval between SE and death was 11.9 ± 11.7 days. Age, duration of SE and hospital stay, history of head trauma and neurosurgery were not predictors of mortality. Negative history for epilepsy had significantly higher mortality rate. Anoxic encephalopathy increased the mortality rate and response to treatment decreased it.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Short-term mortality rate of SE was comparable with most of the previous reports Since our hospital has equipped emergency department, resuscitation and primary treatment of SE is usually start soon, percentage of anoxic encephalopathy is decreased and lower mortality rate is expected. We conclude that early treatment by decrease chance of anoxic encephalopathy, has significant role in outcome of SE.</p></sec>Review articleTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=88Anti-NMDA Receptor Antibody Encephalitis Presenting with Unilateral Non-convulsive Status ...http://www.j-epilepsy.org/journal/view.php?number=89
<p>Anti-N-methyl-D-aspartate (NMDA) receptor antibody encephalitis is an autoimmune antibody encephalitis with psychiatric symptoms, memory disturbances, seizures and abnormal movements. It is more common in young women. We report a young man diagnosed as anti-NMDA receptor antibody encephalitis and presenting with confusion due to non-convulsive status epilepticus involving unilateral hemisphere.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--1-17.jpg' border=0></p>Case ReportTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=89A Case of Hyperventilation Syndrome Mimicking Complex Partial Seizure: Usefulness of EEG ...http://www.j-epilepsy.org/journal/view.php?number=90
<p>Acute hyperventilation syndrome not only can be clinically misdiagnosed as epileptic seizures, but also complex partial seizures may involve hyperventilation as a part of aura. Although electrography (EEG) monitoring is one of the most important procedure to differentiate these conditions, it could not be widely used in emergency department. Variety forms of epileptic attack, mainly idiopathic generalized epilepsy, are provoked by voluntary hyperventilation. In contrast, it is not clear whether hyperventilation can activate the partial seizures. We reported a case of acute hyperventilation syndrome (HSV) mimicking first onset complex partial seizure, impending non-convulsive status epilepticus, which was diagnosed by EEG in the emergency department. The electrographic seizure was provoked again by voluntary hyperventilation after clinical improvement.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--1-20.jpg' border=0></p>Case ReportTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=90Seizures Related to Vitamin B6 Deficiency in Adultshttp://www.j-epilepsy.org/journal/view.php?number=91
<p>Vitamin B6 is closely associated with functions of the nervous, immune, and endocrine systems. Its deficiency may result in neurological disorders including convulsions and epileptic encephalopathy. Until today, this has only been reported in infants, children, and critically ill adult patients. We report a case of a 36year-old man with chronic alcoholism who presented with seizures after gastrointestinal disturbance. His seizures persisted even after treatment with antiepileptic drugs, but eventually disappeared after administration of pyridoxine. Hence, vitamin B6 deficiency may cause seizures in adult patients with chronic alcoholism.</p>Case ReportTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=91Mesial Temporal Lobe Epilepsy in Congenital Toxoplasmosis: A Case Reporthttp://www.j-epilepsy.org/journal/view.php?number=92
<p>Toxoplasmosis is a rare disease caused by intracellular protozoan parasite, Toxoplasma gondii. Though most patients with toxoplasmosis are asymptomatic, congenital toxoplasmosis in the fetus can cause ocular involvement such as chorioretinitis and central nervous system disease including intracerebral calcification, nystagmus, hydrocephalus and microcephaly. Also, these brain lesions can cause seizure secondarily. Our patient was diagnosed with congenital toxoplasmosis, based on toxoplasma-specific serologic test with typical clinical symptoms, including chorioretinitis, nystagmus, hydrocephalus and cerebral palsy. Her brain imaging findings revealed not only the multifocal encephalomalacia, but also multifocal cerebral calcification including intracerebral calcification in left perihippocampal region. Her epileptogenic zone was defined as mesial temporal lobe including hippocampus on left side by seizure semiology, electroencephalogram and neuroimaging including single photon emission computed tomography and 18F-Fluorodeoxyglucose positron-emission tomography. Her seizures were refractory to multiple anti-epileptic drugs. We report a patient with congenital toxoplasmosis who showed intractable mesial temporal lobe epilepsy.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--1-25.jpg' border=0></p>Case ReportTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=92Anti-NMDA Receptor Encephalitis in a Pregnant Womanhttp://www.j-epilepsy.org/journal/view.php?number=93
<p>Anti N-methyl-D-aspartate (NMDA) receptor encephalitis is one of the most common types of autoimmune synaptic encephalitis. Anti-NMDA receptor encephalitis commonly occurs in young women with ovarian teratoma. It has variable clinical manifestations and treatment responses. Sometimes it is misdiagnosed as a psychiatric disorder or viral encephalitis. To the best of our knowledge, anti-NMDA receptor encephalitis is a rare condition in pregnant women. We report a case of anti-NMDA receptor encephalitis in a pregnant woman who presented with abnormal behavior, epileptic seizure, and hypoventilation.</p>Case ReportTue, 30 Jun 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=93Is There Any Scientific Basis of Hawan to be used in Epilepsy-Prevention/Cure?http://www.j-epilepsy.org/journal/view.php?number=94
<p>Epilepsy is a neuropsychiatric disorder associated with religiosity and spirituality. Nasal drug delivery systems are the best for diseases related to brain. In older times RishiMuni, ancient scholars and physicians used to recommend Hawan for mental peace and well being. Gayatri Mantra also tells that sughandhim (aroma, fragrance) puushtivardhanam (gives rise to good health). Om triambkum yajamahe, sughandhim puushtivardhanam, urvarukmev vandhanaat, mrityu mokshay mamritaat! Hawan is a scientific experiment in which special herbs (Hawan Samagri) are offered in the fire of medicinal woods ignited in a specially designed fire pit called agniku?da. Hawan seems to be designed by the ancient scholars to fight with the diseases of the brain. Our metadata analysis demonstrates that the components of Hawan are having a number of volatile oils that are specifically useful for epilepsy through one or the other mechanism of action. Due to high temperature of fire the vapors of these oils enter into the central nervous system through nasal route. The routine of performing Hawan might keep the threshold value of the therapeutic components in the body and help in preventing epilepsy. In the present manuscript authors have tried to highlight and integrate the modern and ancient concepts for treatment and prevention of epilepsy.</p><BR><p align='center'><img src='/upload/thumbnails/er-main--2-33.jpg' border=0></p>Original articleWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=94Efficacy of Retigabine on Acute Limbic Seizures in Adult Ratshttp://www.j-epilepsy.org/journal/view.php?number=95
<sec>
<title>Background and Purpose:</title>
<p>The efficacy of retigabine (RGB), a positive allosteric modulator of K+ channels indicated for adjunct treatment of partial seizures, was studied in two adult models of kainic acid (KA)-induced status epilepticus to determine it’s toleratbility.</p></sec>
<sec>
<title>Methods:</title>
<p>Retigabine was administered systemiclly at high (5 mg/kg) and low (1?2 mg/kg) doses either 30 min prior to or 2 hr after KA-induced status epilepticus. High (1 ?g/?L) and low (0.25 ?g/?L) concentrations of RGB were also delivered by intrahippocampal microinjection in the presence of KA.</p></sec>
<sec>
<title>Results:</title>
<p>Dose-dependent effects of RGB were observed with both models. Lower doses increased seizure behavior latency and reduced the number of single spikes and synchronized burst events in the electroencephalogram (EEG). Higher doses worsened seizure behavior, produced severe ataxia, and increased spiking activity. Animals treated with RGB that were resistant to seizures did not exhibit significant injury or loss in GluR1 expression; however if stage 5?6 seizures were reached, typical hippocampal injury and depletion of GluR1 subunit protein in vulernable pyramidal fields occurred.</p></sec>
<sec>
<title>Conclusions:</title>
<p>RGB was neuroprotective only if seizures were significantly attenuated. GluR1 was simultaneously suppressed in the resistant granule cell layer in presence of RGB which may weaken excitatory transmission. Biphasic effects observed herein suggest that the human dosage must be carefully scrutinized to produce the optimal clinical response.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--2-46.jpg' border=0></p>Review articleWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=95The Relevance of Interictal Bold Changes to Lateralize Seizure Focus Using Simultaneous EEG-fMRIhttp://www.j-epilepsy.org/journal/view.php?number=96
<sec>
<title>Background and Purpose:</title>
<p>The main challenge in assessing patients with epilepsy is the localization of neuronal networks involved in seizure generation and the lateralization of seizure onset. Electro encephalogram-functional magnetic resonance imaging (EEG-fMRI) is a noninvasive multimodal imaging technique for epilepsies where the data is acquired based on the interictal epileptiform discharges (IED). Since this is a new technique, the specificity for lateralizing epileptic focus is yet to be established. The peak blood oxygen level dependent (BOLD) signal in an interictal recording is known to correlate with seizure onset focus. In this study we are proposing a simple and practical method without the need for high end post processing techniques of fmri data. The peak BOLD signal derived from EEG-fMRI aids to lateralise seizure focus in a given cerebral lobe (region of interest, ROI). This is a very useful tool in a clinical setting on a given individual clinical case, when other modalities may be conflicting or inconclusive.</p></sec>
<sec>
<title>Methods:</title>
<p>We analyzed simultaneous EEG-fMRI of 10 different types of refractory epilepsy. The lateralization index was calculated from the statistical significant clusters obtained between the different ROI and results were validated with other modalities.</p></sec>
<sec>
<title>Results:</title>
<p>Lateralization of seizure focus corroborated well in temporal and extratemporal lobe epilepsy, reflex epilepsy and lesional epilepsy. The only drawback of EEG-fMRI in our study was if insignificant BOLD changes were associated with the given IED.</p></sec>
<sec>
<title>Conclusions:</title>
<p>EEG-fMRI can be helpful additional tool in the pre-surgical work-up of refractory epilepsy particularly when lateralization with other modalities is conflicting or inconclusive.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--2-60.jpg' border=0></p>Review articleWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=96Factors Predicting Poor Response to Initial Therapy in Benign Childhood Epilepsy with ...http://www.j-epilepsy.org/journal/view.php?number=97
<sec>
<title>Background and Purpose:</title>
<p>Benign childhood epilepsy with centrotemporal spikes (BCECTS) is the most common pediatric focal epilepsy syndrome and typically has positive clinical outcomes. However, a few patients experience recurrent seizures, and therefore, require treatment with antiepileptic drugs (AEDs). This study aimed to identify risk factors associated with poor response to initial AED therapy in BCECTS patients.</p></sec>
<sec>
<title>Methods:</title>
<p>We retrospectively reviewed the files of 57 patients who were diagnosed with BCECTS between January 2008 and September 2013. Patients not being treated with AEDs have been excluded. We placed the patients into two groups: (1) patients using 1 AED, and (2) patients using 2 AEDs. Clinical characteristics were then collected from the medical records.</p></sec>
<sec>
<title>Results:</title>
<p>Of the 57 patients, 41 (72%) were successfully treated with 1 AED, and 16 (28%) required 2 AEDs to control seizures. Multiple logistic regression analysis indicated that seizure onset prior to age 5 (odds ratio [OR]: 5.65, 95% confidence interval [CI]: 1.41?22.68) and history of febrile seizures (OR: 4.97, 95% CI: 1.06?23.36) were independent risk factors for poor response to initial therapy <italic>(p</italic><0.05). Response to AEDs was not associated with the presence of focal slowing or generalized epileptiform discharges on EEG, abnormalities on MRI of the brain, frequency of afebrile seizures before drug therapy, or family history of febrile seizures or epilepsy.</p></sec>
<sec>
<title>Conclusions:</title>
<p>This study revealed that 28% of patients with BCECTS experienced poor responses to initial AED therapy. Factors predicting poor response to the initial AED included onset of seizures prior to age 5 and history of febrile seizures.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--2-70.jpg' border=0></p>Review articleWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=97Lateralizing Cortical Excitability in Drug Na?ve Patients with Generalized or Focal Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=98
<sec>
<title>Background and Purpose:</title>
<p>Numerous transcranial magnetic stimulation (TMS) studies have defined the characteristic features of TMS in epilepsy. TME parameters were expected to classify the epilepsy syndrome or drug responses. However, the results such as cortical silent periods (CSP) are variable according to conditions of patients. Here, we investigate whether specific TMS parameters have localizing or lateralizing values in drug-na?ve epilepsy patients.</p></sec>
<sec>
<title>Methods:</title>
<p>We recruited 148 consecutive untreated patients with epilepsy (idiopathic generalized epilepsy (IGE) 38, focal epilepsy (FE) 110, mean age 31.4 years) and 38 age- and gender-matched normal subjects. We obtained resting motor threshold (RMT), motor-evoked potential (MEP), CSP, short interval intracortical inhibition (SICI, inter-stimuli interval 2?5 ms), and intracortical facilitation (ICF, inter-stimuli interval 10?20 ms). TMS were performed during a seizure-free state of more than 48 h.</p></sec>
<sec>
<title>Results:</title>
<p>In IGE, no interhemispheric difference in CSP was found (<italic>p</italic> > 0.05). However, the mean CSP was longer in IGE patients than in normal controls at all stimulus intensities (<italic>p</italic> < 0.05). The mean CSP in ipsilateral hemisphere (IH) of FE was significantly longer at all stimulus intensities than that in normal controls (<italic>p</italic> < 0.001). The CSP in IH was longer than that in the contralateral hemisphere of FE. There was no significant difference in CSP between FE and IGE. SICI was significantly reduced only in the IH of FE versus normal subjects. RMT, MEP amplitudes, and ICF did not differ among IGE, FE, and normal controls.</p></sec>
<sec>
<title>Conclusions:</title>
<p>We found that prolonged CSP and reduced SICI in FE indicate asymmetrically increased cortical inhibition and excitation in the epileptic hemispheres. It suggests that CSP among TMS parameters has a crucial role to lateralize the epileptic hemisphere in FE.</p></sec><BR><p align='center'><img src='/upload/thumbnails/er-main--2-75.jpg' border=0></p>Review articleWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=98Clinical Prediction Rule of Drug Resistant Epilepsy in Childrenhttp://www.j-epilepsy.org/journal/view.php?number=99
<sec>
<title>Background and Purpose:</title>
<p>Clinical prediction rules (CPR) are clinical decision-making tools containing variables such as history, physical examination, diagnostic tests by developing scoring model from potential risk factors. This study is to establish clinical prediction scoring of drug-resistant epilepsy (DRE) in children using clinical manifestationa and only basic electroencephalography (EEG).</p></sec>
<sec>
<title>Methods:</title>
<p>Retrospective cohort study was conducted. A total of 308 children with diagnosed epilepsy were recruited. Primary outcome was the incidence of DRE. Independent determinants were patient characteristics, clinical manifestations and electroencephalography. CPR was performed based on multiple logistic regression.</p></sec>
<sec>
<title>Results:</title>
<p>The incidence of DRE was 42%. Risk factors were age onset, prior neurological deficits, and abnormal EEG. CPR can be established and stratified the prediction using scores into 3 levels such as low risk (score<6), moderate risk (score 6?12) and high risk (score>12) with positive likelihood ratio of 0.5, 1.8 and 12.5 respectively.</p></sec>
<sec>
<title>Conclusions:</title>
<p>CPR with scoring risks were stratified into 3 levels. The strongest risk is prior global neurological deficits.</p></sec>Review articleWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=99Safety and Efficacy of Zonisamide in Patients with Epilepsy: A Post-Marketing Surveillance Studyhttp://www.j-epilepsy.org/journal/view.php?number=100
<sec>
<title>Background and Purpose:</title>
<p>Zonisamide (ZNS) is one of new antiepileptic drug, which is known to inhibit seizure through multiple mechanisms of action. In Korea, ZNS was approved as an antiepileptic drug in 1992 and has been used for epilepsy patients with partial and generalized seizures. The objective of this study was to investigate the efficacy and tolerability of ZNS in patients with epilepsy and to identify the incidence of adverse events in real clinical setting.</p></sec>
<sec>
<title>Methods:</title>
<p>This study was carried out in patients who received ZNS for epilepsy. Patients who were observed for at least 12 weeks after treatment with ZNS were included as evaluable subjects. Information regarding the status and type of adverse events occurring during the course of treatment with ZNS was obtained regardless of causal relationship to ZNS and efficacy was assessed by the study physicians and patients at 12 weeks post dose of ZNS.</p></sec>
<sec>
<title>Results:</title>
<p>A total of 1,948 patients were included in the study, and ZNS efficacy was evaluated in 1,744 patients. ZNS was used as a monotherapy in 1,095 patients and as an adjunctive drug in 853 patients. Of the total patients, 1,345 (69.1%) patients had partial seizure, 563 patients had generalized seizure, and 40 patients were undetermined. Adverse events were reported in 65 patients (3.34%) including 1 case of Stevens-Johnson syndrome, but no incidence of serious unexpected adverse drug reactions were reported. 755 patients (43.29%) became seizure free with ZNS treatment, and additional 322 patients (18.41%) experienced marked improvement with ZNS treatment.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Our study shows the safety and tolerability of ZNS treatment in patients with epilepsy in real clinical setting. In addition, ZNS was found to be an effective option as a monotherapy or in patients with generalized seizure.</p></sec>Review articleWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=100Long-Term Migration of a Deep Brain Stimulation (DBS) Lead in the Third Ventricle Caused by ...http://www.j-epilepsy.org/journal/view.php?number=101
<p>The long-term (5-years) antiepileptic effect of deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) against refractory epilepsy has been reported. However, experience with ANT DBS for epilepsy is limited, and so hardware complications and technical problems related to ANT DBS are unclear. We report the case of a 57-year-old male who underwent re-implantation of a DBS lead in the left ANT because of lead migration into the third ventricle detected 8 years after the first DBS, and which was caused by the significant enlargement of the lateral and third ventricles. After re-implantation, the patient showed a mechanically-related antiepileptic effect and a prominent driving response of the electroencephalography was verified. We speculate that progressive dilatation of the ventricle and shallow, insufficient implantation of the lead during the initial ANT DBS may have caused migration of the DBS lead. Because dilatation of the ventricle could progress years after DBS in a patient with chronic epilepsy, regular follow-up imaging is warranted in ANT DBS patients with an injured, atrophied brain.</p>Case ReportWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=101Transient Positive Horizontal Head Impulse Test in Pregabalin Intoxicationhttp://www.j-epilepsy.org/journal/view.php?number=102
<p>Head impulse test (HIT) is helpful to understanding high-frequency vestibulo-ocular reflex in patients with dizziness and imbalance. There are some reports on abnormal HITs in cerebellar disorder. To our knowledge, there was no report of transient bilateral positive head impulse related to antiepileptic drugs. A 65-year-old woman developed dizziness and imbalance after treatment with pregabalin for pain control of radiation cystitis. Neurological examination exhibited positive bilateral HIT results, in addition to ataxia and gaze-evoked rebound nystagmus. Pregabalin intoxication can evoke transient positive horizontal head impulse test as another indicator of cerebellar dysfunction.</p>Case ReportWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=102Ginkgotoxin Induced Seizure Caused by Vitamin B6 Deficiencyhttp://www.j-epilepsy.org/journal/view.php?number=103
<p>Although ginkgo is commonly used as an alternative treatment for memory loss, Alzheimer’s dementia and peripheral circulatory disturbances, it is also known to cause neuronal symptoms due to ginkgotoxin (4′-methoxypyridoxine or B6 antivitamin). We experienced a case of a 51-year-old female patient with generalized tonic clonic seizure and postictal confusion after eating large amounts of ginkgo nuts. Blood vitamin B6 level was decreased. After conservative treatment and pyridoxine medication, her mental symptoms were resolved completely and no seizures recurred.</p>Case ReportWed, 30 Dec 2015 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=103Treatment Strategy for the Patient with Hippocampal Sclerosis Who Failed to the First ...http://www.j-epilepsy.org/journal/view.php?number=74
<p>Despite many epilepsy patients respond to antiepileptic drugs (AED) successfully, more than 30% of patients continue to have seizures on multiple AEDs. The refractory epilepsy increases the risk of cognitive deterioration, psychosocial dysfunction, and sudden unexpected death of epilepsy patients (SUDEP). It is important to identify refractory epilepsy early and make the goal of epilepsy treatment as the prevention of decline in social, vocational, and cognitive performances and minimizing the risk of accident or SUDEP. The syndrome of medial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS) is often resistant to AEDs, and surgically remediable. Initially well-controlled seizures often become intractable to AEDs. There are progressive behavioral changes including increasing memory deficit. Surgical outcome is also worse with longer duration of epilepsy or increasing age at surgery, which suggests that MTLE is a progressive disorder. Some emphasized the ultimate intractability of MTLE in which intractability of MTLE could be evident only after some years following initial diagnosis. However, when patients considered to have intractable epilepsy were followed up for a long period of time, many of them experienced seizure-free state. Some studies clearly demonstrated the wax and wane courses of treatment response in epilepsy. Late remission could be achieved up to in a half of patients. Thus intractable state is not a static condition but a fluctuating one and initial refractoriness does not necessarily mean the final intractability. Even though the chance of seizure remission with AEDs is not high for MTLE, some of them do well respond to drugs. It is even possible to withdraw AEDs for a few patients. Though epilepsy surgery is very effective method to treat MTLE, considering the fluctuation courses of intractability and the possibility of delayed remission, at least two adequate AEDs could be applied to the patients before surgery. However, medical intractability becomes evident by definition, it is not reasonable to delay epilepsy surgery.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--1-1-1.jpg' border=0></p>Original articleMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=74Effect of Androsterone after Pilocarpine-induced Status Epilepticus in Micehttp://www.j-epilepsy.org/journal/view.php?number=69
<sec>
<title>Background and Purpose:</title>
<p>Neurosteroids exert their antiepileptic effects via GABAA and NMDA receptors. Another cell death mechanism is excessive Ca<sup>2+</sup> influx into cells. Calbindin-D28k (CB) is a protein that modulates intracellular Ca<sup>2+</sup> in the nervous system. We evaluated whether androsterone up-regulates the expression of CB and has a neuroprotective effect by controlling Ca<sup>2+</sup> after pilocarpine-induced status epilepticus (SE) in mice.</p></sec>
<sec>
<title>Methods:</title>
<p>SE was induced in ICR mice by injection of pilocarpine. Two hours after SE, mice were treated intraperitoneally (i.p.) with androsterone (100?200 mg/kg) or vehicle, and compared with other control groups. Two days after injection, immunohistochemical staining for CB was performed using a hippocampal slice from each mice group. We also used cresyl violet staining to compare changes in hippocampal structures.</p></sec>
<sec>
<title>Results:</title>
<p>Two days after pilocarpine-induced SE, androsterone increased the expression of CB in the hippocampus compared with control SE mice. The number of CB-positive cells was 1±0.4 cells/mm<sup>3</sup> in pilocarpine-only group, 14±1.1 cells/mm<sup>3</sup> in pilocarpine plus androsterone 100 mg group and 29±2.5 cells/mm<sup>3</sup> in pilocarpine plus androsterone 200 mg group (<italic>p</italic><0.001).</p></sec>
<sec>
<title>Conclusions:</title>
<p>These results suggest that the neuroprotective effect of androsterone after pilocarpine- induced SE may be mediated by an increased expression of CB.</p></sec><BR><p align='center'><img src='/upload/thumbnails/jkes-main--1-7-1.jpg' border=0></p>Review articleMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=69Plasma Brain-Type Natriuretic Peptide Level Following Seizure and Syncope: Pilot Studyhttp://www.j-epilepsy.org/journal/view.php?number=72
<sec>
<title>Background and Purpose:</title>
<p>To explore the clinical feasibility of plasma brain-type natriuretic peptide (proBNP) level to differentiate the two major causes of transient unconsciousness, seizure and vasovagal syncope (VVS) in adult patients.</p></sec>
<sec>
<title>Methods:</title>
<p>ProBNP levels were evaluated within 24 hours following attack in patients who had experienced a transient episode of unconsciousness. For confirmatory diagnosis, clinical history was reviewed thoroughly and several work-ups including electroencephalography and cerebral imaging and tilt-table test, were performed in cases of putative VVS, as a part of routine clinical approaches.</p></sec>
<sec>
<title>Results:</title>
<p>According to various relevant evaluations, 15 patients were diagnosed as seizure (age, 40.3±13.8 years) and 12 patients were VVS (age, 38.1±17.1 years). Plasma concentrations of pro-BNP were not different between two groups (<italic>p</italic>=0.714). Median level was 34.3 pg/mL (interquartile range: 12.9?91.1) in post-seizure group and 32.3 pg/mL (interquartile range 8.9?77.4) in post-VVS group. Additionally, it was not correlated with the sampling times within 24 hours after the episodes.</p></sec>
<sec>
<title>Conclusions:</title>
<p>The plasma level of pro-BNP has a limited clinical value in differentiating seizure and vasovagal syncope in adults. However, the more validated results with a large population should be sought in the future studies to confirm its value.</p></sec><BR><p align='center'><img src='/upload/thumbnails/jkes-main--1-14-1.jpg' border=0></p>Review articleMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=72A Case of Temporal Onset Partial Seizure Induced by Photic Stimulihttp://www.j-epilepsy.org/journal/view.php?number=67
<p>There are only a few case reports of photic stimulation induced partial seizures arising from the temporal lobe. A 12-year-old female with a history of three convulsions was admitted for a diagnostic evaluation. During continuous video-electroencephalogram monitoring, a complex partial seizure with secondary generalization was induced immediately after a photoparoxysmal response with a 15-Hz photic stimulation. This is a rare case of photosensitive temporal lobe seizure.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--1-18-1.jpg' border=0></p>Case ReportMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=67Insulinoma Presenting as Medically Intractable Temporal Lobe Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=70
<p>We describe a female insulinoma patient who presented with recurrent attacks of abnormal behavior, confusion, and seizure. Her interictal EEG showed epileptiform discharges on the left temporal area, therefore she was initially misdiagnosed as temporal lobe epilepsy. In the video-EEG monitoring, hypoglycemic state was detected during the seizure attack, so the right diagnosis was made after the endocrinologic investigations. After surgical removal of the tumor, the patient became seizure-free, and no abnormality was found in the follow-up EEG after six months. Since insulinoma shares some common clinical and EEG features with complex partial seizure of temporal lobe origin, insulioma should be included in the differential diagnosis for medically intractable temporal lobe epilepsy.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--1-21-1.jpg' border=0></p>Case ReportMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=70Dyke-Davidoff-Masson Syndrome: Cases of Two Brothers and Literature Reviewhttp://www.j-epilepsy.org/journal/view.php?number=73
<p>Dyke-Davidoff-Masson syndrome (DDMS) has cerebral hemiatrophy and compensatory ipsilateral skull thickening, and is manifested by recurrent seizures and hemiparesis. We present one case with typical DDMS, who had a brother suffering from epilepsy with mild imaging abnormality relevant to DDMS and similar seizure semiology. A 26-year-old man had a history of developmental delay, mental retardation, hemiparesis and recurrent seizures. His brother, 23-year-old man had also experienced recurrent seizures, but he had no neurological deficits. Older brother experienced focal motor seizures with/without secondary generalization. Sometimes, he noted an auditory aura. MRI demonstrated the hemispheric atrophy with the adjacent bony hypertrophy. The seizures of younger brother were mainly of the auditory type and the MRI showed mild hemispheric atrophy with hippocampal sclerosis without any bony change. Our sibling cases might have a familial predisposition and support the idea that clinical courses and radiological findings of DDMS are varied even within one family.</p>Case ReportMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=73Recurrent Seizures Following Focal Motor Status Epilepticus in a Patient with Non-Ketotic ...http://www.j-epilepsy.org/journal/view.php?number=75
<p>Focal motor status epilepticus (FMSE) is often associated non-ketotic hyperglycemia (NKH). There are no previous reports describing FMSE with NKH that was accompanied by an acute cerebral infarction and its long term follow-up result. We describe the case of a patient having focal motor status epilepticus (FMSE) associated with non-ketotic hyperglycemia (NKH) and acute cerebral infarction who later developed recurrent unprovoked seizures. A small acute infarct was observed in the left frontal subcortical area on diffusion-weighted images (DWI). FMSE was initially controlled with short term antiepileptic drugs and strict glucose control. Two years later, recurrent seizures occurred, and long-term antiepileptic drug treatment was administered. DWI should be considered for acute cerebral infarction in patients having FMSE associated with NKH, and careful follow-up should be conducted for such patients.</p>Case ReportMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=75Posterior Reversible Encephalopathy Syndrome Due to Hyponatremiahttp://www.j-epilepsy.org/journal/view.php?number=68
<p>Posterior reversible encephalopathy syndrome (PRES) is characterized by variable associations of seizure activity, consciousness impairment, headaches, visual abnormalities, nausea/vomiting, and focal neurological signs. The PRES may occur in diverse situations. The findings on neuroimaging in PRES are often symmetric and predominate edema in the white matter of the brain areas perfused by the posterior brain circulation, which is reversible when the underlying cause is treated. We report the case of PRES in normotensive patient with hyponatremia.</p>Case ReportMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=68Mirror Focus in a Patient with Intractable Occipital Lobe Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=71
<p>Mirror focus is one of the evidence of progression in epilepsy, and also has practical points for curative resective epilepsy surgery. The mirror foci are related to the kindling phenomena that occur through interhemispheric callosal or commissural connections. A mirror focus means the secondary epileptogenic foci develop in the contralateral hemispheric homotopic area. Thus mirror foci are mostly reported in patients with temporal or frontal lobe epilepsy, but not in occipital lobe epilepsy. We have observed occipital lobe epilepsy with mirror focus. Before epilepsy surgery, the subject’s seizure onset zone was observed in the left occipital area by ictal studies. Her seizures abated for 10 months after the resection of left occipital epileptogenic focus, but recurred then. The recurred seizures were originated from the right occipital area which was in the homotopic contralateral area. This case can be an evidence that occipital lobe epilepsy may have mirror foci, even though each occipital lobe has any direct interhemispheric callosal connections between them.</p>Case ReportMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=71Old versus New: Why Do We Need New Antiepileptic Drugs?http://www.j-epilepsy.org/journal/view.php?number=76
<p>Achieving complete seizure remission without adverse events is the goal of epilepsy treatment. Recently, many new antiepileptic drugs (AEDs) have been developed. Even though the efficacy of new AEDs is not stronger than that of old AEDs, there are advantages in using new AEDs. They have unique or different mechanisms of action that enable the creation of possible synergistic combinations. They usually exhibit fewer or no pharmacokinetic drug interactions. Furthermore, the response to AEDs varies individually. A similar efficacy does not imply a similar response from all patients. Many new AEDs have fewer adverse events, including induction of congenital malformations. Other concerns about the long-term effects of established AEDs, such as bone health and development of atherosclerosis, may be alleviated by the use of new AEDs. New AEDs are needed to achieve better care of patients with epilepsy.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-39-.jpg' border=0></p>Original articleWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=76Anti-kindling Effect of Bezafibrate, a Peroxisome Proliferator-activated Receptors Alpha ...http://www.j-epilepsy.org/journal/view.php?number=77
<sec>
<title>Background and Purpose:</title>
<p>Studies in the animals suggested that Peroxisome proliferators activated receptors (PPARs) may be involved in seizure control and selective agonists of PPAR α or PPAR γ raise seizure thresholds. The present study was contemplated with the aim of evaluating the anti kindling effects and the mechanism of bezafibrate, a Peroxisome proliferator-activated receptors α (PPAR-α) agonist in pentylenetetrazole (PTZ) induced kindling model of seizures in rats.</p></sec>
<sec>
<title>Methods:</title>
<p>In a PTZ kindled Wistar rat model, different doses of bezafibrate (100 mg/kg, 200 mg/kg and 300 mg/kg) were administered intraperitoneally 30 minutes before the PTZ injection. The PTZ injection was given on alternate day till the animal became fully kindled or till 10 weeks. The parameters measured were the latency to develop kindling and incidence of kindling, histopathological study of hippocampus, hippocampal lipid peroxidation studies, serum neuron specific enolase, and hippocampal DNA fragmentation study.</p></sec>
<sec>
<title>Results:</title>
<p>In this study, bezafibrate significantly reduced the incidence of kindling in PTZ treated rats and exhibited a marked prolongation in the latencies to seizures. In the present study bezafibrate decreased the thiobarbituric acid-reactive substance i.e. Malondialdehyde levels, increased the reduced glutathione levels, catalase and superoxide dismutase activity in the brain. This added to its additional neuroprotective effects. Bezafibrate also reduced the neuronal damage and apoptosis in hippocampal area of the brain. Therefore bezafibrate exerted anticonvulsant properties in PTZ induced kindling model in rats.</p></sec>
<sec>
<title>Conclusions:</title>
<p>These findings may provide insights into the understanding of the mechanism of bezafibrate as an anti kindling agent and could offer a useful support to the basic antiepileptic therapy in preventing the development of PTZ induced seizures, suggesting its potential for therapeutic applications in temporal lobe epilepsy.</p></sec><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-45-.jpg' border=0></p>Review articleWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=77Screening Autoimmune Anti-neuronal Antibodies in Pediatric Patients with Suspected Autoimmune ...http://www.j-epilepsy.org/journal/view.php?number=78
<sec>
<title>Background and Purpose:</title>
<p>The aim of this study was to identify and describe the pediatric autoimmune encephalitis cases positive for anti-neuronal antibody tests.</p></sec>
<sec>
<title>Methods:</title>
<p>Screening of six anti-neuronal antibodies in 23 children with suspected autoimmune encephalitis was performed by cell-based indirect immunofluorescence test with patients’ serum or cerebrospinal fluid.</p></sec>
<sec>
<title>Results:</title>
<p>Among the 23 cases enrolled here, eight patients (35%) were positive for the anti-N-methyl-d-aspartate (NMDA) receptor antibody and one patient (4%) was positive for the anti-contactin-associated protein-like 2 (CASPR2) antibody. In the anti-NMDA receptor antibody-positive group, seizure and movement disorders were the most prominent features and were present in all patients. A tumor was present in only one patient. Three patients with infant- and toddler-onset disease did not exhibit a classic multistage illness. In addition to seizure and dyskinesia, aphasia or mutism without severe consciousness impairment was present in all three patients. These atypical clinical presentations may suggest different pathomechanism of anti-NMDA receptor encephalitis among these age groups. The patient who was positive for the anti-CASPR2 antibody was an 8-year-old girl who presented with fever, encephalopathy, and seizure. Neuromyotonia or other dyskinesia was not present.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Eight anti-NMDA receptor antibody positive patients and one CASPR2 positive patient were identified from the screening of six anti-neuronal antibodies in pediatric patients suspected with autoimmune encephalitis. Developmental regression specifically for language skills was suggested as one of the atypical clinical features in infants and toddler onset anti-NMDA receptor antibody positive patients.</p></sec>Review articleWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=78A Muliticenter Retrospective Study of the Actual Using Patterns and Clinical Effects of ...http://www.j-epilepsy.org/journal/view.php?number=79
<sec>
<title>Background and Purpose:</title>
<p>This study is to investigate the actual using patterns and clinical effects of topiramate in patients with neurosurgical disease as antiepileptic drugs (AEDs) in 94 korean multicenters.</p></sec>
<sec>
<title>Methods:</title>
<p>A total of 7,152 patients who had taken topiramate for at least 3 months between August 2008 and February 2009 were eligible to participate in this study. We evaluated demographic data, disease entities, duration of topiramate administration, initial and subsequent dosage adjustment, concomitant AEDs, the frequency of seizure reduction, and adverse events.</p></sec>
<sec>
<title>Results:</title>
<p>Topiramate was commonly prescribed in stroke (38%) and head trauma group (36%). In the dosage of topiramate, the mean initial dosage was 65 mg/day, and the mean maintenance dosage was adjusted into 105 mg/day. The mean duration of the initial dosage for topiramate administration was 24 days, and the mean duration of the maintenance dosage was 125 days, respectively. Among groups with prophylactic administration, 98% did not develop convulsion and among groups with therapeutic administration, 2% was ineffective to control seizure. After taking topiramate, 2% patients showed adverse events, that sensory aberration was the most common.</p></sec>
<sec>
<title>Conclusions:</title>
<p>These results suggest that topiramate prescribe widely in diverse neurosurgical disorders, and effective in reduction of seizure frequency, and does not cause serious adverse effects comparable with old AEDs.</p></sec><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-62-.jpg' border=0></p>Review articleWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=7918F-Fluorodeoxyglucose Positron-Emission Tomography Findings with Anti-N-Methyl-D-Aspartate ...http://www.j-epilepsy.org/journal/view.php?number=80
<p>Catatonia is one of the main symptoms of anti-N-Methyl-D-aspartate receptor (NMDAR) encephalitis. However, it is unknown whether metabolic changes observed with <sup>18</sup>F-Fluorodeoxyglucose positron-emission tomography (FDG-PET) are correlated with the severity of the catatonic symptoms and clinical course. Three patients with anti-NMDAR encephalitis showing variable degrees of catatonia were performed with FDG-PET scans during the acute and recovery phase. PET findings showed hypermetabolism in the frontotemporoparietal regions and bilateral basal ganglia in the patient with mild catatonia, but more widespread hypermetabolic regions including the thalamus and brainstem were observed in the patients with more severe catatonia. Follow-up PET scans in one patient showed mild hypermetabolism in the right basal ganglia that correlated with mild rigidity and tonic posturing in the left extremities. Extent of cerebral metabolic changes correlates with the severity of catatonia accompanied by behavioural, motor, autonomic, and breathing abnormalities in anti-NMDAR encephalitis.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-69-.jpg' border=0></p>Case ReportWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=80Two Cases of Crossed Cerebellar Diaschisis with or without Thalamic Lesion on Brain MRI in ...http://www.j-epilepsy.org/journal/view.php?number=81
<p>We report two cases of status epilepticus who showed crossed cerebellar diaschisis (CCD) with or without pulvinar high signal intensity (HSI) on brain magnetic resonance imaging (MRI). The first patient had CCD with pulvinar HSI on MRI and periodic lateralized epileptiform discharges (PLEDs) on electroencephalography. MRI of the second patient revealed CCD without pulvinar HSI. And electroencephalography (EEG) of this patient did not show PLEDs. The authors suggest that the pulvinar lesion might be related to the generation of PLEDs in Status epilepticus.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-74-.jpg' border=0></p>Case ReportWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=81Unusual Ictal Foreign Language Automatisms in Temporal Lobe Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=82
<p>The distinct brain regions could be specifically involved in different languages and the differences in brain activation depending on the language proficiency and on the age of language acquisition. Speech disturbances are observed in the majority of temporal lobe complex motor seizures. Ictal verbalization had significant lateralization value: 90% of patients with this manifestation had seizure focus in the non-dominant temporal lobe. Although, ictal speech automatisms are usually uttered in the patient’s native language, ictal speech foreign language automatisms are unusual presentations of non-dominent temporal lobe epilepsy. The release of isolated foreign language area could be possible depending on the pattern of ictal spreading of non-dominant hemisphere. Most of the case reports in ictal speech foreign language automatisms were men. In this case report, we observed ictal foreign language automatisms in middle age Korean woman.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-78-.jpg' border=0></p>Case ReportWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=82Valproic Acid-induced Hyperammonemic Encephalopathy Promoted by Levetiracetamhttp://www.j-epilepsy.org/journal/view.php?number=83
<p>Encephalopathy resulting from the administration of levetiracetam (LEV) is a rare occurrence. We experienced a patient receiving LEV treated with valproic acid (VPA) for partial seizures with secondary generalization, following which she developed hyperammonemic encephalopathy and showed complete recovery after the drug was withdrawan. LEV is able to promote hyperammonemic encephalopathy when added to VPA.</p>Case ReportWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=83Cefepime-induced Aphasic Status Epilepticus Mimicking Acute Strokehttp://www.j-epilepsy.org/journal/view.php?number=84
<p>Cefepime-induced neurotoxicity, including nonconvulsive status epilepticus, has been reported especially in patients with renal impairment. However, focal nonconvulsive status epilepticus is very rare and cefepime-induced aphasic status epilepticus proven by electroencephalography have never been reported to our knowledge. We present an interesting case of aphasic status epilepticus mimicking acute stroke in a patient treated by cefepime.</p>Case ReportWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=84Unusual Lesion in the Bilateral External Capsule Following Status Epilepticus: A Case Reporthttp://www.j-epilepsy.org/journal/view.php?number=85
<p>Magnetic resonance imaging (MRI) is an essential tool for determining the underlying cause of status epilepticus and can exhibit a variety of unpredictable findings. A 28-year-old woman presented with status epilepticus of unknown etiology. She had been recovered from status epilepticus twenty days later, but afterwards developed transient postural instability and cognitive impairment. Initial MRI showed no abnormalities. Follow-up MRI after cessation of status epilepticus demonstrated hyper-intensities lesions in the right claustrum and bilateral external capsular areas on T2 fluid attenuated inversion recovery images. As the external capsule is a route for cholinergic and corticostriatal fibers, cognitive dysfunction and postural instability might be related to these fibers.</p>Case ReportWed, 31 Dec 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=85Benign Childhood Epilepsy with Centrotemporal Spikes: To Treat or Not to Treathttp://www.j-epilepsy.org/journal/view.php?number=28
<sec>
<title>Background and Purpose:</title>
<p>The aim of this study was to evaluate the benefits and risks of oxcarbazepine (OXC) monotherapy in children with newly diagnosed, benign partial epilepsy based on clinico-electrical and neuropsychological evaluation over time.</p></sec>
<sec>
<title>Methods:</title>
<p>The study was open label, prospective, multicenter based. A total of 39 children with BRE were involved in the study. They were randomized into two groups (T; treatment with OXC, NT; No treatment) to compare the effectiveness of OXC treatment. All children underwent EEGs with quantification and a comprehensive battery of neuropsychological tests at the first visit and follow up visit at 6 months.</p></sec>
<sec>
<title>Results:</title>
<p>The subjects made a slight progress in general intelligence measures over time in both groups (95.4±10.5 to 97.6±7.5 for T, 107.6±17.3 to 111.4±18.6 for NT). Memory and frontal executive functions did not change over time in both groups in terms of the memory quotient (MQ) (106.7±27.5 to 103.4± 19.3 for T, 105.8±13.2 to 104.9±17.2 for NT) and executive intelligence quotient (EIQ) (114.7±18.3 to 108.9±12.5 for T, 100.6±25.1 to 101.2±13.9 for NT). However, when sub-domain scores were compared between the two groups, the treatment group got significantly worse over time in the verbal fluency test (11.5±3.8 to 8.0±1.4 for T, 10.3±3.9 to 11.5±2.1 for NT; <italic>p</italic><0.05) and level 1 of Stroop test (9.3±3.0 to 7.5±1.3 for T, 11.0±3.7 to 11.2±2.6 for NT; <italic>p</italic><0.05). The subjects might have cognitive and behavioral difficulties in association with frontal lobe dysfunctions, but these difficulties did not seem to be dependent on the number of seizures, the abundance of subclinical epileptiform discharges, or the anti-epileptic treatment.</p></sec>
<sec>
<title>Conclusions:</title>
<p>We think that OXC monotherapy is effective for children with BRE, but is to be given to the selected patients such as patients with prolonged or frequent seizures. However, further studies are needed to have a better understanding in this matter.</p></sec>Review articleMon, 30 Jun 2014 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=28Effect of Oxcarbazepine on Background EEG Activity and Cognition in Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=29
<sec>
<title>Background and Purpose:</title>
<p>Cognitive dysfunction related to antiepileptic drugs (AEDs) is an important issue in the management of patients with epilepsy. The aim of the present study was to evaluate relative long-term effects of oxcarbazepine (OXC) on cognition in drug-naive patients with epilepsy.</p></sec>
<sec>
<title>Methods:</title>
<p>Fifteen drug-na?ve epilepsy patients were enrolled. Electroencephalogram (EEG) recordings and neuropsychological (NP) tests were performed before and after OXC monotherapy. The relative power of the discrete frequency bandwas obtained. In addition, interhemispheric and intrahemispheric spectral coherence was also calculated.</p></sec>
<sec>
<title>Results:</title>
<p>NP tests showed significant improvement in visuo-spatial, memory and executive function after OXC treatment. However, neither spectral power nor coherence changed significantly with OXC treatment.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Our study supports the notion that OXC has no significant cognitive side effect in patients with epilepsy.</p></sec>Review articleSun, 30 Jun 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=29Long-Term Outcome of Vagus Nerve Stimulation for Refractory Epilepsy: A Longitudinal 4 year ...http://www.j-epilepsy.org/journal/view.php?number=30
<sec>
<title>Background and Purpose:</title>
<p>We evaluated the long-term outcome of patients with refractory epilepsy who were treated with vagus nerve stimulation (VNS).</p></sec>
<sec>
<title>Methods:</title>
<p>This investigation is designed as an uncontrolled, open-label, retrospective and long-term study. From June 1999 to October 2009, 20 patients were suitable for inclusion criteria: 4-year follow-up and documented seizure frequency before and after implantation. Seizure frequency was collected by clinical recording and interview. Primary outcome measures were the reduction in mean seizure frequency and responder rate (seizure frequency reduction of >50%).</p></sec>
<sec>
<title>Results:</title>
<p>In 20 patients (M:F=16:4), mean age at the time of implantation was 22.3 years (range 8?44) and mean disease duration was 13.9 years (range 1?37). Mean maximum stimulation output current was 1.90 mA (range 0.25?3.5). Overall mean seizure frequency reduction rate was 61.8% at 4 year follow-up comparison with baseline (<italic>p</italic><0.001). Proposition of responder (> 50% seizure frequency reduction) of yearly follow-up were 40 % at 1 yr, 50% at 2 yrs, 45% at 3 yrs, and 60% at 4 yrs. There was no difference of stimulation parameter between the responders and non-responders.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Long-term outcome of VNS suggests that VNS is an effective treatment option that can be alternative to surgery in patients with refractory epilepsy.</p></sec>Review articleSun, 30 Jun 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=30Propofol Infusion Syndrome in Refractory Status Epilepticushttp://www.j-epilepsy.org/journal/view.php?number=31
<sec>
<title>Background and Purpose:</title>
<p>Propofol is used for treating refractory status epilepticus, which has high rate of mortality. Propofol infusion syndrome is a rare but often fatal syndrome, characterized by lactic acidosis, lipidemia, and cardiac failure, associated with propofol infusion over prolonged periods of time. We investigated the clinical factors that characterize propofol infusion syndrome to know the risk of them in refractory status epilepticus.</p></sec>
<sec>
<title>Methods:</title>
<p>This retrospective observation study was conducted in Samsung medical center from Jan. 2005 to Dec. 2009. Thirty two patients (19 males, 13 females, aged between 16 and 64 years), with refractory status epilepsy were included. Their clinical findings and treatment outcomes were evaluated retrospectively. We divided our patients into established status epilepticus (ESE) and refractory status epilepticus (RSE). And then the patients with RSE was further subdivided into propofol treatment group (RSE-P) and the other anesthetics treatment group (RSE-O). We analyzed the clinical characteristics by comparison of the groups.</p></sec>
<sec>
<title>Results:</title>
<p>There were significant differences of hypotension and lipid change between ESE and RSE (<italic>p</italic><0.05). However, there was no significant difference between RSE-P and RSE-O groups. The hospital days were longer in RSE than in ESE (<italic>p</italic>=0.012) and treatment outcome was also worse in RSE than in ESE (<italic>p</italic>=0.007) but there were no significant differences of hospital stays and treatment outcome between RSE-P and RSE-O.</p></sec>
<sec>
<title>Conclusions:</title>
<p>RSE is very critical disease with high mortality, which may show as many clinical changes as propofol infusion syndrome. Therefore propofol infusion syndrome might be considered as one of the clinical manifestations of RSE.</p></sec><BR><p align='center'><img src='/upload/thumbnails/jer-3-1-21.png' border=0></p>Review articleSun, 30 Jun 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=31Relapsed Herpes Simplex Virus Encephalitis after Epilepsy Surgeryhttp://www.j-epilepsy.org/journal/view.php?number=32
<p>Relapsed herpes simplex virus (HSV) encephalitis after neurosurgery is a very rare condition. An 11-year-old boy suffered from relapsed HSV encephalitis five days after neurosurgery to remove the epileptogenic focus six years after prior HSV encephalitis. He was diagnosed with HSV encephalitis reactivation after positive HSV polymerase chain reaction results following a lumbar puncture, and this diagnosis was supported by consistent radiologic and histopathologic findings. Moreover, focal cortical dysplasia coexisted with inflammatory changes resulting from a viral infection based upon the removed brain tissue. This case may support the hypothesis that neurosurgery may be a triggering factor of HSV reactivation.</p>Case ReportSun, 30 Jun 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=32Thalamic Hyperintensity on Diffusion-Weighted MRI in a Patient with Nonconvulsive Status Epilepticushttp://www.j-epilepsy.org/journal/view.php?number=33
<p>We present a 70-year-old woman with nonconvulsive status epilepticus (NCSE) with thalamic hyperintensity on diffusion-weighted MRI (DWI). She had no previous history of epilepsy. Her altered mentality was not normalized though we successfully controlled the ictal activity by standard treatment. Initial DWI showed diffuse hyperintensity in the right thalamus, which raised the possibility of seizure-related change. At the follow-up DWI, more localized high signal intensity lesion was present in the right pulvinar area. There was no apparent cause of her NCSE despite our extensive work-ups. The authors suggest that transient ischemia is a possible causative pathomechanism in this case.</p>Case ReportSun, 30 Jun 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=33Surgical Treatment of Mesial Temporal Lobe Epilepsy in a Patient with Neurofibromatosis Type 1http://www.j-epilepsy.org/journal/view.php?number=34
<p>Neurofibromatosis type 1 (NF1) is the most common neurocutaneous disease. Main neurologic manifestations are represented by neoplasms such as optic gliomas, but epilepsy can occur by CNS lesions in less than 10%. Our patient was diagnosed, based on caf?-au-lait spots and axillary freckles. Her brain MRI did not show only multiple CNS lesions, like hamartomas, but also mesial temporal lesions. On brain-MRI the mesial temporal lesions had increased high signal intensities and suspiciously increased volume. Moreover scalp lesions could be confirmed by thin-slice, fat suppression, enhanced lesions on skin and subcutaneous areas, indicating neurofibromas. The seizure onset zone was confirmed by presurgical evaluation including electrophysiology and neuroimaging. Her seizures were refractory to multiple antiepileptic drugs, but became free after anteromesial temporal resection. We report a patient with the NF1 in mesial temporal lobe epilepsy. Epilepsy surgery was also effective in this case.</p><BR><p align='center'><img src='/upload/thumbnails/jer-3-1-35.png' border=0></p>Case ReportSun, 30 Jun 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=34Cefepime- Induced Non-Convulsive Status Epilepticus (NCSE)http://www.j-epilepsy.org/journal/view.php?number=35
<p>Cefepime is a fourth-generation B-lactam cephalosporin, commonly used in immunosuppressed patients. Neurotoxicity, which present as nonconvulsive status epilepticus (NCSE), has been reported previously especially in adult patients with impaired renal function. We present a case of cefepime induced NCSE after recovering from acute renal failure. A 71-year-old woman was hospitalized for right lower lobe lobectomy after diagnosis of lung cancer. Although she had successful lobectomy, she underwent several post operative complication including operation site bleeding, acute renal failure, acute respiratory distress syndrome, and atypical pneumonia. Her renal failure was prerenal type after massive operation site bleeding, and continuous renal replacement therapy (CRRT) were started for renal replacement treatment. After 5 days of renal replacement therapy, her serum creatinine level was much improved from 2.7 mg/dL to 1.33 mg/dL. Cefepime renal dose were started, when atypical pneumonia became resistant to imipenem and vancomycin. After 5th day of cefepime use, the patient became stupor and developed one episode of brief generalized myoclonic seizure. Her electroencephalograph (EEG) revealed 2?3 Hz generalized sharp and with impression of NCSE, she was started on anti-epileptic treatment. Clinical symptoms improved 3 days after discontinuation of cefepime. She was than diagnosed with cefepime induced non convulsive status epilepticus. Anti-epileptic treatments were than discontinued uneventfully. Awareness of the potential neurotoxic clinical manifestations of various antibiotics and high degree of vigilance in critically ill patients is essential in identifying a potentially serious though reversible complication of antibiotic therapy.</p>Case ReportSun, 30 Jun 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=35Focal Cortical Dysplasia and Epilepsy Surgeryhttp://www.j-epilepsy.org/journal/view.php?number=63
<p>Focal cortical dysplasia (FCD) is the most commonly encountered developmental malformation that causes refractory epilepsy. With advances in neuroimaging techniques, in particular MRI, recent studies have revealed a higher prevalence of FCD than previously estimated and have improved the preoperative identification and classification of these abnormalities. However, MRI frequently does not show any abnormalities in patients with pathologically proven FCD. In this situation, functional neuroimaing such as FDG-PET and ictal SPECT can be helpful. FCD is thought to be intrinsically epileptogenic, because the dysplastic tissues contain aberrant neural networks that are highly susceptible to abnormal excitation. The response to the medical treatment of epilepsy has been documented as consistently poor. Therefore, surgical resection has been an important alternative treatment for patients with intractable epilepsy related to FCD. Incomplete resection of FCD has been consistently known to be a poor prognostic factor. However, the complete removal of FCD is often difficult because the demarcation of the lesion is frequently poor, and dysplastic tissues tend to be more extensive than is apparent on MRI. Evidence indicates that even patients with MRI abnormalities who have resective epilepsy surgery for FCD have worse surgical outcomes than those of patients who have surgery for other focal lesional epilepsy syndromes. Careful planning of evelauation using intracranial electrodes is necessary for successful epilepsy surgery.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-43-2.jpg' border=0></p>Original articleMon, 30 Dec 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=63Epilepsy Surgery in Pediatric Intractable Epilepsy with Destructive Encephalopathyhttp://www.j-epilepsy.org/journal/view.php?number=62
<sec>
<title>Background and Purpose:</title>
<p>The aim of the current study is to review the clinical features, surgery outcomes and parental satisfaction of children with destructive encephalopathy who underwent epilepsy surgery due to medically intractable seizures.</p></sec>
<sec>
<title>Methods:</title>
<p>48 patients who underwent epilepsy surgery from October 2003 to August 2011 at Severance Children’s Hospital have been reviewed. The survey was conducted for functional outcomes and parental satisfaction at least 1 year after the surgery.</p></sec>
<sec>
<title>Results:</title>
<p>Epileptic encephalopathy including Lennox-Gastaut syndrome and infantile spasms was more prevalent than symptomatic focal epilepsy. Hypoxic ischemic injury accounted for most of the underlying etiology of the destructive encephalpathy, followed by central nervous system infection and head trauma. 27 patients (56.3%) underwent resective surgery and 21 patients (43.7%) underwent palliative surgery. 16 patients (33.3%) achieved seizure free and 27 parents (87.5%) reported satisfaction with the outcome of their children’s epilepsy surgery. In addition, 14 parents (77.8 %) whose children were not seizure free reported satisfaction with their children’s improvement in cognitive and behavior issues.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Epilepsy surgery in destructive encephalopathy was effective for controlling seizures. Parents reported satisfaction not only with the surgical outcomes, but also with improvement of cognitive and behavior issues.</p></sec>Review articleMon, 30 Dec 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=62The Significance of Insular Hypometabolism in Temporal Lobe Epilepsy in Childrenhttp://www.j-epilepsy.org/journal/view.php?number=65
<sec>
<title>Background and Purpose:</title>
<p>Temporal lobe epilepsy is one of the most common forms of medically refractory epileptic syndromes. In a small percentage, temporal lobectomy fails to control the seizures in patients with epilepsy of clear temporal origin, and in some of these patients, seizures originating from the insular cortex is believed to be the cause behind the surgical failures. We retrospectively analyzed the [<sup>18</sup>F]FDG-positron emission tomography (PET) results of patients who received temporal lobe surgery for presence of insular hypometabolism, and compared the surgical outcome to verify whether insular hypometablism was related with difference in post-operative results.</p></sec>
<sec>
<title>Methods:</title>
<p>13 patients were enrolled, and clinical variables, post-operative pathology, magnetic resonance imaging and PET results were analyzed for possible differences between the patients with or without insular hypometabolism.</p></sec>
<sec>
<title>Results:</title>
<p>7 patients showed insular hypometabolism, while 6 patients were clear of insular lesion on PET exam. 8 patients received anterior temporal lobectomy with amygdalohippocampectomy (AH), 2 patients received radical temporal lobectomy with AH, and 3 patients received insular cortisectomy. Post-operative results were favorable in 8 patients and unfavorable in 5, with unfavorable outcomes in all recipients of insular cortisectomy. Presence of insular hypometabolism did not have any significant relationship with the post-surgical outcome (<italic>p</italic>=0.266), but its trend showed a tendency towards favorable outcome if insular hypometabolism was not present.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Presence of insular hypometabolism in [<sup>18</sup>F]FDG-PET analysis was not significantly correlated with the post-operative outcome, and recipients of insular cortisectomy among our patients with insular hypometabolism resulted in poor surgical outcome. However, the outcome trend showed a tendency towards better surgical outcome with absence of hypometabolic lesion in the ipsilateral insular cortex. Further studies employing a larger patient group is needed.</p></sec><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-54-2.jpg' border=0></p>Review articleMon, 30 Dec 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=65Zonisamide Decreases Current-Source Density of High Beta Frequency of Electroencephalogramhttp://www.j-epilepsy.org/journal/view.php?number=64
<sec>
<title>Background and Purpose:</title>
<p>The purpose of this study was to investigate changes in brain current-source density (CSD) of the high frequency band (22?30 Hz) induced by zonisamide (ZNS) in patients with newly diagnosed epilepsy and to correlate with the cognitive performances.</p></sec>
<sec>
<title>Methods:</title>
<p>We conducted a 24-week, open-labeled, prospective study in 19 patients. Eelectroencephalography (EEG) and neuropsychological tests (NPs) were conducted at baseline and 24 weeks after starting the medication. Six patients were excluded due to artifacts in EEG. One patient did not attend follow-up studies. Twelve patients who completed follow-up EEG and NPs were included. We used low-resolution brain electromagnetic tomography to determine CSD, and we obtained statistical nonparametric maps for the high beta frequency band (22?30 Hz) between pretreatment EEGs and post-treatment EEGs.</p></sec>
<sec>
<title>Results:</title>
<p>The CSD in the 22?30 Hz band decreased in the superior frontal, middle frontal, anterior cingulate, precentral, postcentral, and inferior parietal gyri of the left hemisphere, and the middle frontal, inferior frontal and anterior cingulate gyri of the right hemisphere. Among the NPs items, the performance of verbal fluency was significantly impaired after the 24-week ZNS trial.</p></sec>
<sec>
<title>Conclusions:</title>
<p>The CSD changes suggest ZNS may diminish the activity of cerebral networks related to verbal fluency.</p></sec><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-63-2.jpg' border=0></p>Review articleMon, 30 Dec 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=64Hashimotohttp://www.j-epilepsy.org/journal/view.php?number=60
<p>Hashimoto’s encephalopathy is an immune-mediated disorder characterized by acute or subacute encephalopathy related to increased anti-thyroid antibodies. Clinical manifestations of Hashimoto’s encephalopathy may include stroke-like episodes, altered consciousness, psychosis, myoclonus, abnormal movements, seizures, and cognitive dysfunction. Acute cognitive dysfunction with convulsion as initial clinical manifestations of Hashimoto’s encephalopathy is very rare. We report a 65-year-old man who developed acute onset of cognitive decline and convulsion due to Hashimoto’s encephalopathy.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-70-2.jpg' border=0></p>Case ReportMon, 30 Dec 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=60A Case with Dopamine-Antagonist Responsive Repetitive Head Punching as Rhythmic Movement ...http://www.j-epilepsy.org/journal/view.php?number=66
<p>We reported a 17-year-ole male presented with repetitive head punching as rhythmic movement during sleep. Rhythmic movement disorder (RMD) during sleep refers to a number of activities characterized by repetitive stereotyped movements such as rhythmic oscillations of the head, limbs, or body. The repetitive movement like punching on the head in our case is a rare form. The patient’s symptom was dramatically aggravated by dopamine agonist and responded well to dopamine antagonist. It is the first case report of dopamine-antagonist responsive repetitive head punching as rhythmic movement during sleep.</p>Case ReportMon, 30 Dec 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=66Ictal Neuropsychological Assessment in a Patient with Transient Global Amnesiahttp://www.j-epilepsy.org/journal/view.php?number=61
<p>Transient global amnesia (TGA) is a temporary amnestic syndrome characterized by anterograde amnesia and variable retrograde amnesia without other focal neurological deficits. Neuropsychological tests during attack in TGA have been rarely reported. We report a 62-year-old man with TGA who was evaluated with detailed neuropsychological tests during attack. Ictal neuropsychological tests showed encoding failure in verbal and visual memory with frontal/executive dysfunction.</p><BR><p align='center'><img src='/upload/thumbnails/jkes-main--2-76-2.jpg' border=0></p>Case ReportMon, 30 Dec 2013 00:00:01 +0100http://www.j-epilepsy.org/journal/view.php?number=61Mitochondrial Diseaseshttp://www.j-epilepsy.org/journal/view.php?number=57
<p>Mitochondria contain the respiratory chain enzyme complexes that carry out oxidative phosphorylation and produce the main part of cellular energy in the form of ATP. Although several proteins related with signalling, assembling, transporting, and enzymatic function can be impaired in mitochondrial diseases, most frequently the activity of the respiratory chain protein complexes is primarily or secondarily affected, leading to impaired oxygen utilization and reduced energy production. Mitochondrial diseases usually show a chronic, slowly progressive course and present with multiorgan involvement with varying onset between birth and late adulthood. Neuromuscular system is frequently affected in mitochondrial diseases. Although there is actually no specific therapy and cure for mitochondrial diseases, the understanding of the pathophysiology may further facilitate the diagnostic approach and open perspectives to future in mitochondrial diseases.</p>Original articleThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=57Relationship between Hyperventilation-Induced Electroencephalographic Changes and PCO2 Levelhttp://www.j-epilepsy.org/journal/view.php?number=49
<sec>
<title>Background and Purpose:</title>
<p>We conducted this study to define the relationship between the hyperventilation-induced EEG changes (HV-EEG changes) and PCO<sub>2</sub></p></sec>
<sec>
<title>Methods:</title>
<p>In consecutive EEG recordings of 190 patients, we gathered data on PCO<sub>2</sub> during the hyperventilation procedure. The data included baseline PCO<sub>2</sub> (B-PCO<sub>2</sub>), PCO<sub>2</sub> after 5 min of hyperventilation (5 min-PCO<sub>2</sub>), the mean value of the PCO<sub>2</sub> (M-PCO<sub>2</sub>), and the difference between B-PCO<sub>2</sub> and 5 min-PCO<sub>2</sub> (ΔPCO<sub>2</sub>). We divided the enrolled patients into two groups by hyperventilation response (response group and no-response group), presence of epilepsy (epileptic group and non-epileptic group) and age (child-adolescent group and adult group) repeatedly. We compared the four variables between the two groups in each pair.</p></sec>
<sec>
<title>Results:</title>
<p>ΔPCO<sub>2</sub> was 14.2±5.0 mmHg (mean±SD) in response group (n=48) and 12.4±5.0 in no-response group (n=142; <italic>p</italic>=0.033) for all the patients. For adult patients only, 5 min-PCO<sub>2</sub> was 24.3±3.4 in response group (n=30) and 26.2±4.6 in no-response group (n=115; <italic>p</italic>=0.048), and ΔPCO<sub>2</sub> was 15.8±4.0 and 12.9±5.0, respectively (<italic>p</italic>=0.004). In non-epileptic patients, 5min-PCO<sub>2</sub> was 23.4±2.2 in response group (n=7) and 26.3±3.8 in no-response group (n=44; <italic>p</italic>=0.026), and ΔPCO<sub>2</sub> was 15.9±4.3 and 12.7±3.9, respectively (<italic>p</italic>=0.053).</p></sec>
<sec>
<title>Conclusions:</title>
<p>In adults and non-epileptic patients, ΔPCO<sub>2</sub> and 5 min-PCO<sub>2</sub> may be crucial to the induction of EEG changes by hyperventilation. PCO<sub>2</sub> could be a crucial factor for provoking HV-EEG changes in a limited group of patients.</p></sec>Review articleThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=49Kl?ver-Bucy Syndrome with Isolated Bilateral Hippocampal Atrophy Following Status Epilepticushttp://www.j-epilepsy.org/journal/view.php?number=53
<p>Kl?ver-Bucy syndrome may result from affection of various location of brain. We report a case of Kl?ver-Bucy syndrome associated with isolated bilateral hippocampal atrophy without any abnormal lesion in other areas following status epilepticus. A 31-year-old man who had no significant medical history presented with status epilepticus after encephalitis of unknown etiology. He had been recovered from status epilepticus three weeks later, but afterwards he developed Kl?ver-Bucy syndrome: hyperphagia, hypersexuality, hypermetamorphosis, anterograde amnesia and dysosmia. Initial brain MRI showed T2 hyperintensity and swelling of isolated bilateral hippocampus, especially CA1 region without any abnormal lesion in other areas. One month later, follow-up brain MRI showed isolated bilateral hippocampal atrophy. This is a meaningful case report because this case differs from other reports of Kl?ver-Bucy syndrome in humans in that the anatomic abnormalities revealed by MRI were very selective. We report this case because this case is very educative for above reason. Moreover, this report would give us additional information of the relationship between human behavior and limbic system.</p>Case ReportThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=53Vigabatrin-Induced Generalized Epileptiform Discharges in a Patient with Focal Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=50
<p>Vigabatrin (VGB) may aggravate clinical seizures and epileptiform discharges especially in the patients with generalized epilepsy. This report is about the repetitive appearance of generalized spike-and-wave complexes in a patient with focal epilepsy. Though there were constant appearances of the generalized epileptiform discharges on the consecutive electroencephalograms (EEGs) taken over approximately four years under VGB monotherapy, clinical provocation of primary generalized seizures was not occurred. Because of the repetitive observations of the generalized epileptiform discharges, valproic acid was added and the tapering of VGB was started. On the EEG taken during the tapering period of VGB and another EEG after the discontinuation of VGB, the generalized epileptiform discharges were completely disappeared. Through observation in this case, we suggests that the use of VGB could induce generalized epileptiform discharges without clinical seizure induction for long term period.</p>Case ReportThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=50Seizure Localization in Patients with Multiple Tubers: Presurgical Evaluation in Tuberous Sclerosishttp://www.j-epilepsy.org/journal/view.php?number=55
<p>Tuberous sclerosis complex (TSC) is an autosomal dominant disorder. Epileptic seizure is the most common neurological symptom. Medically intractable epilepsy in these patients is candidates of epilepsy surgery. We report two cases of TSC with ictal electroencephalography (EEG) arising from right temporal lobe who underwent video-EEG monitoring. Two of these patients were first diagnosed with TSC at age 30 and 23 years old, partly because of their mild accompanying symptoms other than epileptic seizures. Case 1 had a long history of epilepsy since three years old. Although she had multiple cortical tubers on her magnetic resonance imaging (MRI) scan, all the recorded ictal and interictal EEG indicated epileptic focus on right temporal region, suggesting that cortical tuber located at the anterior temporal region as epileptogenic tuber. Case 2 also had long history of epilepsy since three years old. His brain MRI revealed numerous tubers in his brain including one at the right hippocampus. His ictal EEG originated from right temporal area, suggesting hippocampus as epileptic focus. Epileptic focus in TSC are commonly localized to one of the multiple cortical tubers, which is epileptogenic. The localization of epileptogenic zone can be aided with interictal and ictal EEG, brain MRI, subtracted ictal-interictal SPECT co-registered with MRI (SISOM) and positron emission tomography (PET).</p>Case ReportThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=55An Unusual Case of Herpes Simplex Viral Encephalitis Following Acute Retinal Necrosis after ...http://www.j-epilepsy.org/journal/view.php?number=52
<p>Acute retinal necrosis (ARN), a viral retinal disease with poor visual prognosis, following herpes simplex encephalitis (HSE) are uncommonly seen, and there has been no case yet reported of the reverse situation. We herein present the reverse situation, an immune-competent patient with HSE following ARN. A 57-year-old man who had been under steroid therapy for retinal vasculitis the prior two weeks, presented with abrupt confusion and high fever. His cerebrospinal fluid study and brain magnetic resonance imaging revealed typical HSE. Ophthalmic examination and polymerase chain reaction of the vitreous specimen revealed ARN by herpes simplex virus type 2. Intravenous acyclovir treatment improved his encephalitis symptoms and retinal necrosis. This case implies that ARN may be a risk factor for HSE and the virus may reach the brain from the eye. Inappropriate administration of a systemic steroid may exacerbate herpes viral infection in the retina, with subsequent spread to the brain.</p>Case ReportThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=52Clinical Application of TMS to Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=54
<p>The role of transcranial magnetic stimulation in epileptology is discussed in this article. Usefulness of TMS are discussed as a diagnostic tool in testing altered cortical excitability in patients with epilepsy and the modes of action of antiepileptic drugs, which are helpful to evaluate the pathophysiology of epilepsy. Also potential therapeutic tool in epilepsy with repetitive transcranial magnetic stimulation would be mentioned.</p>Original articleThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=54Anticonvulsant Effects of http://www.j-epilepsy.org/journal/view.php?number=51
<sec>
<title>Background and Purpose:</title>
<p>The ketogenic diet was formulated to mimic the biochemical changes seen upon fasting, specifically the formation of ketone bodies. Recent research data suggest that the anticonvulsant efficacy of the KD may be due in part to the direct actions of ketone bodies. This study was designed to investigate the anticonvulsant effects of β-hydroxybutyrate (BHB) on pilocarpine-induced seizures in mature mice.</p></sec>
<sec>
<title>Methods:</title>
<p>Eighty-two male ICR mice at postnatal day 49 were used. All mice were pretreated with scopolamine methylbromide prior to pilocarpine injection. Experimental mice (n=42) were injected intraperitoneally with BHB (20 mmol/kg) 15 min prior to pilocarpine administration, while control animals (n=40) with normal saline. Pilocarpine (300 mg/kg) was administered intraperitoneally and mice were monitored for 2 h after pilocarpine injection.</p></sec>
<sec>
<title>Results:</title>
<p>All mice developed typical seizure behaviors. The mean (±SD) latency to the onset of seizures was significantly prolonged in the BHB-treated mice compared with controls (4.83±1.95 min vs. 3.67±1.90 min, <italic>p</italic><0.01).</p></sec>
<sec>
<title>Conclusions:</title>
<p>This study demonstrates that treatment with BHB prolongs the latency to the onset of seizures induced by pilocarpine in mature mice and suggests that BHB, one of the ketone bodies, may have direct anticonvulsant effects.</p></sec>Review articleThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=51The Efficacy and Tolerability of Rufinamide in Intractable Pediatric Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=56
<sec>
<title>Background and Purpose:</title>
<p>Rufinamide (RUF) is a novel antiepileptic drug (AED) and its efficacy has been proven in Lennox-Gastaut syndrome (LGS). However, there is a lack of data regarding the efficacy in pediatric intractable epilepsies other than LGS. The purpose of the study was to explore the efficacy and tolerability of RUF in pediatric patients with intractable epilepsies as well as LGS.</p></sec>
<sec>
<title>Methods:</title>
<p>This retrospective observation study was conducted in Samsung medical center from August 2010 to September 2011. Thirty seven patients (27 males, 10 females, aged between 1.8 and 18.4 years), with refractory epilepsies or LGS were treated with RUF as an adjunctive drug. Efficacy was represented by the response rate and retention rate over the study period. Tolerability was measured as the number of patients who showed adverse effects.</p></sec>
<sec>
<title>Results:</title>
<p>The overall response rate was 21.6% during the 12 months of the study period with 5.4% of seizure-free patients. The retention rate was 54% and ineffectiveness was the most common reason for discontinuation of RUF. The most common adverse effects were insomnia and somnolence.</p></sec>
<sec>
<title>Conclusions:</title>
<p>RUF may be considered to be an efficacious and safe AED for pediatric patients with intractable epilepsies as well as LGS.</p></sec>Review articleThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=56New Classification of Focal Cortical Dysplasia: Application to Practical Diagnosishttp://www.j-epilepsy.org/journal/view.php?number=59
<sec>
<title>Background and Purpose:</title>
<p>Malformation of cortical development (MCD) is a well-known cause of drug-resistant epilepsy and focal cortical dysplasia (FCD) is the most common neuropathological finding in surgical specimens from drug-resistant epilepsy patients. Palmini’s classification proposed in 2004 is now widely used to categorize FCD. Recently, however, Blumcke <italic>et al</italic>. recommended a new system for classifying FCD in 2011.</p></sec>
<sec>
<title>Methods:</title>
<p>We applied the new classification system in practical diagnosis of a sample of 117 patients who underwent neurosurgical operations due to drug-resistant epilepsy at Severance Hospital in Seoul, Korea.</p></sec>
<sec>
<title>Results:</title>
<p>Among 117 cases, a total of 16 cases were shifted to other FCD subtypes under the new classification system. Five cases were reclassified to type IIIa and five cases were categorized as dual pathology. The other six cases were changed within the type I category.</p></sec>
<sec>
<title>Conclusions:</title>
<p>The most remarkable changes in the new classification system are the advent of dual pathology and FCD type III. Thus, it will be very important for pathologists and clinicians to discriminate between these new categories. More large-scale research needs to be conducted to elucidate the clinical influence of the alterations within the classification of type I disease. Although the new FCD classification system has several advantages compared to the former, the correlation with clinical characteristics is not yet clear.</p></sec>Review articleThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=59Two Cases of Chromosome 22q11.2 Deletion Syndrome Diagnosed in 12-Year-Old Boys with ...http://www.j-epilepsy.org/journal/view.php?number=58
<p>Chromosome 22q11.2 deletion syndrome is the most common interstitial deletion syndrome. Major clinical manifestation includes hypocalcemia secondary to hypoparathyroidim. At least 10% of the patients with this syndrome had hypocalcemic seizures which are generally improved over the first year of life because of the increase of parathyroid gland hypertrophy and dietary calcium intake. We present two cases of this syndrome diagnosed in 12-year-old boys with new onset hypocalcemic seizures. This case report hopes to call attention to this syndrome as a potential cause of hypocalcemic seizures even after the neonatal period. Furthermore, our first patient showed inheritance from a paternal deletion which is not as common as maternal deletions. This is the first case report of hypocalcemic seizure with a paternally inherited 22q11.2 deletion in Korea.</p>Case ReportThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=58A Case of Psychogenic Dizziness Mimicking Vestibular Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=48
<p>A 28-year-old patient presented with frequent episodes of clockwise whirling vertigo, with no ear symptoms or anxiety. He had a previous history of encephaloduroarteriosynangiosis from Moyamoya disease 3 years ago. We assumed that the ictus was a manifestation of vestibular epilepsy. Although the patient was monitored continuously with video and computerized electroencephalography equipment for 24 hours, his vertigo was not accompanied by electroencephalographic discharges. And thorough vestibular evaluation was normal. His symptom was alleviated by psychological support. Psychogenic dizziness may also manifest as recurrent whirling vertigo with unilateral directionality.</p>Case ReportThu, 01 Jan 1970 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=48Consensus Guideline for the Assessment of Fitness for Private Driving of Persons with Epilepsy ...http://www.j-epilepsy.org/journal/view.php?number=1
<p>Korea lacks practical guideline regarding driver’s licensing for persons with epilepsy. Therefore, these consensus guidelines would be useful for assessing the fitness of persons with epilepsy for as drivers of personal vehicles in Korea. In the guidelines, a person with chronic epilepsy may receive a driver’s license after a seizure-free period of two years. A person with seizures occurring only during sleep or with simple partial seizures (that would not impair driving safety) may receive a driver’s license, if no other seizures that might impair their safe driving have occurred for at least two years. A person with newly-diagnosed epilepsy or an isolated seizure may receive a driver’s license after a seizure-free period of one year. Driving should be prohibited during withdrawal of medication and for 12 months after withdrawal. These guidelines apply to drivers of personal vehicles but not to commercial drivers.</p>Original articleFri, 25 Mar 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=1Increased Expression of Tumor Necrosis Factor-Alpha in the Rat Hippocampus after Acute ...http://www.j-epilepsy.org/journal/view.php?number=2
<sec>
<title>Background and Purpose:</title>
<p>This paper evaluated the effect of acute homocysteine administration on inflammatory cytokine tumor necrosis factor-alpha (TNF-α) expression and neuronal apoptosis in the rat hippocampus and investigated the effects of vitamin C treatment on homocysteine-induced inflammation and neuronal death.</p></sec>
<sec>
<title>Methods:</title>
<p>Subjects were three-week-old, male Sprague-Dawley rats. Rats for the control group, we injected saline solution into the rats’ abdominal cavities for one week. Rats in the second group received 1 injection of homocysteine (11 mmol/kg) into their abdominal cavities after 1 week of saline solution administration. For the third group, we injected the rats with vitamin C (100 mg/kg) for a week, followed by 1 injection of homocysteine. The hippocampi were stained with an anti-TNF-α antibody, and apoptosis was evaluated using the TUNEL staining method.</p></sec>
<sec>
<title>Results:</title>
<p>The homocysteine-injected rats had strong TNF-α expression in every hippocampal region. Vitamin C significantly reduced TNF-α expression in the hippocampus’s CA1 region. Acute homocysteine administration did not cause apoptosis in the hippocampus.</p></sec>
<sec>
<title>Conclusions:</title>
<p>The pro-inflammatory cytokine TNF-α may mediate elevated homocysteine levels’ contributions to inflammatory reactions, and vitamin C has some protective effect on inflammatory reactions in the CA1 hippocampal region.</p></sec>Review articleFri, 25 Mar 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=2Characteristics of Epilepsy Patients who Committed Violent Crimes: Report from the National ...http://www.j-epilepsy.org/journal/view.php?number=3
<sec>
<title>Background and Purpose:</title>
<p>We investigated the clinical and criminal characteristics of patients with epilepsy who had committed violent crimes in order to understand the mechanism of violence and to prevent future criminal activity.</p></sec>
<sec>
<title>Methods:</title>
<p>We reviewed medical and legal reports of criminals with epilepsy who were incarcerated in the Korean National Forensic Hospital between October 2007 and September 2008.</p></sec>
<sec>
<title>Results:</title>
<p>Of 761 criminals admitted to the National Forensic Hospital, 17 patients (2.2%) were diagnosed with epilepsy. All of them had localization-related epilepsy, and no patient reported an overt seizure attack around the time of a crime. Psychosis was present in eight patients, and seven patients were in a drunken state at the time of the crimes. There was a positive correlation between the patients’ age at their first crime and their intelligence quotient score.</p></sec>
<sec>
<title>Conclusions:</title>
<p>These results suggest that most violent crimes take place during interictal periods, and diverse medical conditions, including inebriation, psychosis, and low intelligence, are associated with violent crimes among epileptic patients.</p></sec>Review articleFri, 25 Mar 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=3Comparative Study between Febrile Convulsions and Benign Convulsions Associated with Viral ...http://www.j-epilepsy.org/journal/view.php?number=4
<sec>
<title>Background and Purpose:</title>
<p>This study was performed to compare the clinical features between febrile convulsions and benign convulsions associated with viral gastroenteritis.</p></sec>
<sec>
<title>Methods:</title>
<p>We retrospectively reviewed the medical records of 706 children admitted to the Sunlin Hospital for either febrile convulsions or benign convulsions with viral gastroenteritis, between January 1, 2006, and December 31, 2009. We classified them into group A for febrile convulsions (N = 631), group B for non-rotavirus gastroenteritis (N = 43) and group C for rotavirus gastroenteritis (N = 32). Then we analyzed and compared the characteristics between the three groups.</p></sec>
<sec>
<title>Results:</title>
<p>The mean ages (± SD) of group A, B and C were 28.3 ± 17.9, 21.2 ± 22.0, and 22.0 ± 18.7 months, respectively. Group A admissions were prevalent in the spring, and group C admissions were prevalent in the winter. There was a family history of febrile convulsions in 55.6% of group A patients, 46.5% of group B patients, and 34.4% of group C patients. Cluster convulsions during hospitalization were observed more in group B and group C than in group A (23.3%, and 18.8% vs. 6.3%, <italic>p</italic> < 0.01). In afebrile convulsions with diarrhea, recurrence occurred in 33.3% of patients, while recurrence occurred in only 10.3% in febrile cases (<italic>p</italic> = 0.015).</p></sec>
<sec>
<title>Conclusions:</title>
<p>All studied groups showed favorable prognoses. However, the groups differed in the following characteristics: distribution of the month of admission, age, the family history of febrile convulsions, fever occurrence, and recurrence. In afebrile convulsions with gastroenteritis, cluster convulsions were more likely to occur within 24 h from admission.</p></sec>Review articleFri, 25 Mar 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=4Encephalitis Associated with Acute Hepatitis Ahttp://www.j-epilepsy.org/journal/view.php?number=5
<p>Encephalitis is caused by multiple organisms, but rarely by the hepatitis A virus. A 27-year-old man visited our hospital because of fever, altered consciousness, and seizures. On physical exam, a stuporous mentality and neck stiffness were found. On laboratory exam, elevated liver enzymes and cerebrospinal fluid abnormalities, including pleocytosis and elevated protein levels were observed. The hepatitis A virus (HAV) IgM antibody was also detected. We conclude that these findings were compatible with encephalitis associated with HAV and discuss the pathomechanisms.</p>Case ReportFri, 25 Mar 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=5Refractory Status Epilepticus Spontaneously Resolved by Parturitionhttp://www.j-epilepsy.org/journal/view.php?number=6
<p>Status epilepticus (SE) in pregnancy is very rare, and there are only a few case reports of refractory SE (RSE) during pregnancy. The patient was a 27-year-old primigravida woman with a 21-year history of seizures from cortical dysplasia. At 23 weeks of pregnancy, the patient’s seizure frequency progressively increased, and the patient came to the ER in a confused mental state and with intermittent convulsive movements of her left arm. Electroencephalography (EEG) revealed repeated seizures. She was admitted to the ICU, and continuous EEG monitoring was done. Treatment was immediately started with various anti-SE medications, but her SE was not controlled. A cesarean section was done, and SE spontaneously stopped two weeks after the parturition. Parturition may be beneficial and the best treatment option in pregnant patients with RSE.</p>Case ReportFri, 25 Mar 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=6Two Patients Diagnosed with Juvenile Myoclonic Epilepsy by First-Ever Status Epilepticus in ...http://www.j-epilepsy.org/journal/view.php?number=7
<p>Juvenile myoclonic epilepsy (JME) is an idiopathic, age-related generalized epileptic syndrome. Status epilepticus (SE) in JME is very rare, and little is known about its etiology. We report 2 cases of adult patients, retrospectively diagnosed as JME by non convulsive status epilepticus which occurred for the first time. One patient was a 52-year-old woman who was presented with confusion and brief generalized tonic-clonic seizure (GTCS) for the first time. The other patient, a 39 year-old woman, visited the ER with transient LOC following confused mental state. Electroencephalograms of both patients repetitively showed generalized polyspikes and slow waves which were disappeared after IV injection of lorazepam. With careful history taking, both of them the patients were diagnosed as JME, and the seizures stopped just after sodium valproate medication. NCSE in patients with JME is rare but detailed history taking and suspicion of the disorder is helpful for diagnosis.</p>Case ReportFri, 25 Mar 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=7New and Emerging Treatments for Epilepsy: Review of Clinical Studies of Lacosamide, ...http://www.j-epilepsy.org/journal/view.php?number=8
<p>Although many different medical and surgical treatment options for epilepsy exist, approximately 30% of epilepsy patients remain poorly controlled. For those patients who are refractory to medical treatment, epilepsy surgery often provides meaningful improvement. However, when surgical resection of epileptic foci cannot be offered or failed, combined administration of AEDs or the application of novel AEDs is the most appropriate therapeutic options. The most recent AEDs tend to offer new mechanisms of action and more favorable safety profiles than the first generation of AEDs. More recently, alternative options of thalamic or cortical stimulation emerged as potentiall effective treatment for epilepsy. The purpose of this article is to compare and review clinical information for the new and emerging medications such as lacosamide, eslicarbazepine acetate, ezogabine (retigabine), rufinamide, perampanel, as well as deep brain stimulation and responsive neurostimulation devices.</p>Original articleFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=8Surgical Approaches in Nonlesional Neocortical Epilepsyhttp://www.j-epilepsy.org/journal/view.php?number=9
<p>There is inherent difficulty in identifying the epileptogenic zone in nonlesional neocortical epilepsy, which leads to the incomplete resection. However, with careful interpretation of other studies including functional neuroimaging and the presence of concordant results, surgical treatment can benefit selected patients with nonlesional neocortical epilepsy. Two recent large studies including ours demonstrated that seizure free outcomes were 47 and 55% for nonlesional TLE, and 41 and 43% for nonlesional extratemporal lobe epilepsy patients. Concordance with two or more presurgical evaluations among interictal EEG, ictal EEG, FDG-PET, and ictal SPECT was significantly related to a seizure-free outcome. However, we should be cautious to the possibility of false localization of ictal EEG or functional neuroimaging in nonlesional neocortical epilepsy. Careful placement of intracranial electrodes on the presumed epileptogenic zone and the adjacent areas should be needed for these patients. The repositioning of intracranial electrodes after the failure in identifying ictal onset zone at the initial intracranial study might identify a new ictal onset zone. Consideration of one-week interval repositioning of intracranial electrodes could be helpful in selected patients. Intracranial EEG is one of the most important procedures in planning surgery and achieving a good surgical outcome in resective epilepsy surgery. Slow propagation and focal or regional ictal onset rather than widespread onset were associated with a seizure-free outcome. Complete resection including the area with initial three second ictal rhythm and interictal abnormalities predicts a good surgical outcome.</p>Original articleFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=9Effectiveness of Topiramate in Medically Complicated Patients with Status Epilepticus or Acute ...http://www.j-epilepsy.org/journal/view.php?number=10
<sec>
<title>Background and Purpose:</title>
<p>The conventional therapeutic regimen for status epilepticus (SE) may require artificial ventilation and hemodynamic support, and is associated with significant complications and increased mortality. We investigated the safety and effectiveness of topiramate (TPM) in patients with refractory SE, who had medical complications such as systemic infection, renal dysfunction, hepatic dysfunction, and bone marrow suppression.</p></sec>
<sec>
<title>Methods:</title>
<p>We analyzed the clinical features and therapeutic outcome in 16 patients with GCSE, NCSE or recurrent GTC in whom TPM was administered for its control.</p></sec>
<sec>
<title>Results:</title>
<p>The majority of our patients had GCSE (n=6) or NCSE (n=7). The common co-morbid diseases at the onset of seizures were hematological disorders (pancytopenia 8, anemia 2, anemia with thrombocytopenia 2) and sepsis (n=8). Twelve patients were under the renal and/or hepatic dysfunction. Within a few days, 13 patients could experience their seizure control (the mean duration, 3.7± 2.6 days), but the seizures of the other subjects did not be terminated in spite of all efforts. No patients experienced a worsening of their CBC or blood chemistry profiles with the TPM treatment.</p></sec>
<sec>
<title>Conclusions:</title>
<p>We could confirm that TPM was not only safe but very effective for the control of recurrent epileptic seizures or SE in patients with serious medical co-morbidities. TPM may be considered as another treatment option when conventional protocols are ineffective.</p></sec>Review articleFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=10Seizure Duration Determined by Subdural Electrode Recordings in Adult Patients with Intractable ...http://www.j-epilepsy.org/journal/view.php?number=11
<sec>
<title>Background and Purpose:</title>
<p>To investigate the duration of seizures and its relationship to seizure type, epilepsy syndrome, and seizure clustering.</p></sec>
<sec>
<title>Methods:</title>
<p>We examined 1,251 seizures from 152 patients who underwent video-electrocorticographic monitoring with subdural electrodes. Their seizure duration, seizure types, epilepsy syndromes, and seizure clusters were analyzed.</p></sec>
<sec>
<title>Results:</title>
<p>The median seizure duration was 91.5s (4?1016s). There were 34 (2.7%) seizures lasting > 5 minutes in 20 (13.2%) patients. There was a significant difference in seizure duration according to seizure types (<italic>p</italic> < 0.0001), but not to epilepsy syndromes. There were 99 seizure clusters in 67 (44.1%) patients. The first seizure in a cluster of seizures tended to last longer than non-cluster seizures (median 98s versus 89s, <italic>p</italic> = 0.033). Seizure duration was significantly longer in mesial temporal lobe epilepsy than in neocortical lobe epilepsy (median 103s versus 87s, <italic>p</italic> = 0.041). Rate of seizure cluster was lower in mTLE (38.0%) than in NLE (47.1%), but this difference was not significant.</p></sec>
<sec>
<title>Conclusions:</title>
<p>Seizure durations were different among seizure types. Seizure clustering also differ between patients with mTLE and those with NLE, which suggests different seizure generation and propagation among different epileptogenic foci. This study has implications for the identification of abnormally prolonged seizures.</p></sec>Review articleFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=11Predictive Value of Electroencephalography for Seizure Outcome Following Corpus Callosotomy in ...http://www.j-epilepsy.org/journal/view.php?number=12
<sec>
<title>Background and Purpose:</title>
<p>This study aimed to determine whether preoperative or postoperative electroencephalography (EEG) can predict surgical outcome for corpus callosotomy.</p></sec>
<sec>
<title>Methods:</title>
<p>We retrospectively reviewed the medical records of 16 patients enrolled. We compared postoperative seizure outcome according to seizure type, preoperative interictal EEG, preoperative ictal EEG, and postoperative interictal EEG. Seizure outcome was classified according to postoperative seizure reduction, i.e., seizure free, >90%, 50?90%, <50%, and no change or worsened. A seizure reduction of 50% or more was judged as a “favorable outcome”.</p></sec>
<sec>
<title>Results:</title>
<p>Most patients showed a favorable outcome (12 patients, 75%) and two patients became seizure free (13%). Atonic seizure was most responsive to corpus callosotomy. Preoperative interictal epileptiform discharge had 3 patterns; bilateral independent, generalized, and combination of independent and generalized. None of the preoperative interictal epileptiform discharge (EDs) had significant correlation with seizure outcome. The preoperative ictal rhythm did not predict seizure outcome. However disappearance of generalized EDs on postoperative EEG was correlated with favorable seizure outcome.</p></sec>
<sec>
<title>Conclusions:</title>
<p>The presence of generalized EDs on postoperative interictal EEG predicted seizure outcome, whereas preoperative EEG did not.</p></sec>Review articleFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=12Staged Total Callosotomy for Lennox-Gastaut Syndrome: A Case Reporthttp://www.j-epilepsy.org/journal/view.php?number=13
<p>We report a case with Lennox-Gastaut syndrome (LGS) who underwent staged total callosotomy with a favorable outcome. A 6-year-old boy began having myoclonic seizures at the age of 8 months and was diagnosed with LGS when he was 27 months old. Various antiepileptic drugs and a ketogenic diet failed to control his multiple types of seizures. At the age of 36 months, he underwent corpus callosotomy and achieved an immediate, post-operative seizure free state. However, 3 months later, various seizures relapsed and were refractory to additional vagus nerve stimulation. Remaining callosal fibers in the splenium noted on post-operative diffusion tensor imaging made us to perform a second operation, total callosotomy. The patient finally achieved a seizure-free state with electroencephalography (EEG) normalization noted after the staged total callosotomy.</p>Case ReportFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=13Nocturnal Frontal Lobe Epilepsy Presenting as Obstructive Type Sleep Apneahttp://www.j-epilepsy.org/journal/view.php?number=14
<p>A 20-year-old man presented with sleep apnea. Polysomnography was performed and it revealed nine apneas and two hypopneas. Contrary to typical apnea, however, rhythmic epileptiform discharges appeared at bifrontal area on EEG just before the start of apnoea. Video-EEG monitoring was performed to classify these events, and to evaluate the relationship of apnoea and ictal discharge. Ictal EEG revealed paroxysmal fast activity over the bifrontal area. Ictal SPECT showed hyperperfusion in right frontal area. Given these findings, we concluded that these events were epileptic seizures presenting as obstructive sleep apnea. Antiepileptic medication was initiated, and the events were decreased. This case demonstrates that nocturnal frontal love epilepsy may be the potential cause of obstructive sleep apnea (OSA).</p>Case ReportFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=14Simple Partial Status of Forced Thinking Originated in the Mesial Temporal Region: Intracranial ...http://www.j-epilepsy.org/journal/view.php?number=15
<p>Forced thinking (FT) is a rare epileptic phenomenon which is usually seen in patients with frontal lobe epilepsy. We report a rare case of mesial temporal lobe epilepsy presenting FT as simple partial status epilepticus. A 50-year-old woman with left hippocampal sclerosis developed a prolonged episode of continuous FT for five days after she experienced a clustering of complex partial seizures during the period of preoperative video-electroencephalography (EEG) monitoring. The EEG demonstrated continuous focal ictal discharges in the left foramen ovale electrodes. Positron emission tomography showed focal glucose hypermetabolism in the left mesial temporal region. This case indicates that the anatomical substrate for the development of FT is located in the mesial temporal region as well as the frontal lobe, and prolonged FT can occur as a seizure manifestation.</p>Case ReportFri, 30 Dec 2011 09:00:00 +0100http://www.j-epilepsy.org/journal/view.php?number=15